Am I responsible for what I do while manic and what can I do about it?

responsibilityI do everything I can to not get manic, but sometimes it creeps in.  Those who love me know that and I am lucky as that is better than most people have.

Yes- I am responsible for the things I do while manic, but people who know me and that I have this illness understand that it was “not me” doing those things. They know if I was not manic, I would not have done them.

When I do things while manic, I am not thinking of the consequences.  I just am doing them.  When my world is rocked and I come back to myself again, I am almost always depressed.  Part of what causes me to be depressed is feeling badly and embarrassed about the things I did while manic.

I hate myself for my irrational behavior and that pulls me deeper into depression.

The trick for me is to not get manic as I regret almost everything I do while manic.  Unfortunately, it sometimes creeps in no matter what I do.

I said yes I am responsible for the things I did while manic, but at the same time, I have to ease up on myself and know that I was sick when I did them and not be so hard on myself.  Making amends to people I have hurt is one thing I try to do.  The money I have spent on things I don’t need, I return as much of it as I can.  I somehow can hide  my mania from a lot of people so they don’t know.  I try and act as normal as I can when I am manic.  I held down jobs this way.   No one knew I had bipolar disorder unless I told them and when I did, they were shocked.

The best things I can do is to prevent myself from getting manic by getting enough sleep, eating right, confiding with people I trust when I think I am spiraling out of control, seeing my doctor, watching my stress level, exercising on a regular basis and taking my medicine.  When I am depressed which is most of the time, it is hard to motivate myself to do these things, however.

So- I am responsible for what I do when I am manic. However, I am not usually to blame for getting manic as I have already stated that I do everything I can to prevent it.  I have stated that I am responsible for everything I do, but at the same time, I am not sure I should be held accountable too much to those who love and care about me as they know about my struggles.  Yes- I still make amends with them and I am sure they probably get sick of it, like I do, but I am  lucky that they love me unconditionally and forgive me.  I know that they struggle right along with me.

I realize I was a little wishy-washy there, but that is because as easy it is to say I am accountable, if I take that on with a full heart, I would  never come out of depression.

One piece of advice, is yes take responsibility, but don’t dwell on the past and right as many wrongs as soon as possible.










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How to be Around People when you are Depressed

crowdsWhen you are in a deep depression, it is hard to motivate yourself to do anything.  It can be difficult to get out of bed, take a shower, talk to friends and even family, exercise, or find anything that you enjoy.

So, if you can’t even get out of bed, how in the world are you supposed to talk to anyone?

I am somewhat an introvert anyway unless I am manic.  Therefore when I am depressed, I am even more apt to  not want to talk to anyone and it is torturous to be in a large crowd.

When I am depressed and don’t want to even go outside, how am I supposed to go to a function and not make it obvious I  am depressed. I can tell some people, but most peopl don’t understand so I don’t bother explaining.

People have asked me why I am so quiet.  What do I tell them?

I try to avoid going out anywhere, but there are some times I have to go be around people. For example, I recently had  go to a graduation party.  I dreaded it because I knew I  would be around people. Granted, I knew some of them, but very few of those people knew  I suffered from bipolar disorder and even the ones that do don’t really understand deep depression.

I suppose the way I deal with people when I am depressed is fake it until I make it.  I  tried to hang around my husband most of the time, but when he went off and did other things with friends he had not seen in years, I was left alone and only knew a few of his family members and others.  I just give that fake smile (yes-the one that people who suffer from depression have to do) and would try to listen to others and say something once in awhile so it was not totally awkward.  Thank goodness there were some people who loved to talk so  it was not too strange I did not say much.

Luckily, I found someone who I did not know who struck up a conversation with me and we kept the conversation going for a long time. I was proud of myself for doing that.  If I had my choice I would have crawled up into a ball and not talk to anyone. I actually enjoyed the conversation. Of course, there is always the question what do I do for a living.  I can answer I used to be a teacher and worked for my dad for awhile, but am currently looking. It is mostly telling the truth, but I am on disability and I can’t just tell someone that I hardly know.

I have not written in awhile because I have been depressed and can’t think of any topics that might interest anyone.   I like to end on a positive note and try to “teach” something to my readers. I am not sure if this does either one, but wanted to write something.

On a positive note, like I like to end it:  You can do it!     The worst thing that can happen is people think you are strange or quiet and you can just brush that off.  Like my dad says, “who cares what people think”  I know that is easier said than done.

Be proud of yourself for forcing yourself into the situation even though you have been dreading it for weeks.  Pat yourself on the shoulder knowing that you did the best you could do.  You pushed yourself and got out of the house and will actually feel better by doing so.

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Guest Post: Sleeping and Mental Health by MA Sleep Institute

sad sleeperA bit of background on sleep and mental illness

While historically our theory on the interplay between mental illness and sleep disorders was simply that mental illness can cause sleep disorders. Recent research has made the link between the two stronger and more complicated.

As opposed to mental illness being the cause of sleep disorders, new evidence suggests that sleep disorders can cause and/or exacerbate mental illness. The relationship between the two groups of ailments varies based on the specific disorders involved and can change on a case-by-case basis.

One mental illness may develop in part due to a specific sleep disorder, but it can also be a symptom of the same mental illness — creating a positive feedback loop. Some mental issues may show no causal relationships with sleep at all. And some sleep disorders have no relationship with mental disorders whatsoever.

Mental illness and sleep disorders are still fairly misunderstood compared to other pathologies, in no small part because of their origin in the wild, unexplored frontier of the human brain. Only about fifty years ago did we end the barbaric and widespread use of lobotomies and electroshock therapy used to cure a whole host of mental disorders in the mid 20th century — including depression, anxiety, or even the perceived sickness of homosexuality.

Just now we’re beginning to understand the complex synergy between mental and sleep health, and we’re still only on the cusp of reaching a basic understanding of these interactions.

Let’s take a look at the overlap between these disorders.

Sleep disorder prevalence amongst individuals with mental health issues

With one in six U.S. adults suffering from some form of mental illness and 10-18% of adults living with a chronic sleep problem, understanding the causal factors involved in the two groups of disorders and the interplay between them is no small issue.

It’s been known for years that those with mental issues are at a much greater risk for sleep disorders than those without. While about one in five Americans suffers from some sort of chronic sleep disorder, four out of five Americans with mental health issues have an accompanying sleep issue.

  • Somewhere between 65% to 90% of adults with depression suffer from a sleep disorder.
    • The most common sleep disorder among those with depression is insomnia, but 20% suffer from (the more easily treated) sleep apnea.
  • For adults with anxiety disorder, 50% also suffer from a sleep disorder.
  • Those with bipolar disorder are plagued with sleep disorders at a rate anywhere between 69-99%.
  • About 25-50% of children with ADHD suffer from a sleep disorder.

Unsurprisingly, the most common sleep ailments here are insomnia and hypersomnia (sleeping excessively) during manic and depressive phases respectively.

While not all with mental health issues present a sleep disorder, it’s clear that a great many do.

Now that we’ve established a strong basic link between the two issues, let’s delve into the synergy between them and think about the methodology used to determine this link.

How do we determine that sleep disorders can cause or exacerbate mental illness?

There are a few ways to try and figure this out.

One approach is to identify people presenting sleep disorders with no evidence of mental health issues as determined by testing and follow them over time. While a robust approach, it does leave to question whether the same genetic, lifestyle or psychological factors that could cause sleep issues may also play a role in depression that tends to manifest itself at a later date than the sleep disorder (see lurking variable).

This study from the Henry Ford Health Sciences Center makes use of this type of experimental design and serves as much of the basis for what we know about sleep disorders potentially leading to mental health issues.

Additionally, to see if sleep disorders can worsen mental illnesses, we need to see if treating a sleep disorder (but not necessarily psychiatric issues) helps to improve the psychiatric issue. This may hint that sleep disorders can be a cause of mental illness. However, due to the structure, we can only say with certainty that the presence or severity of sleep disorders can affect the severity of mental health issues.

study from Oxford has provided some of the most compelling research on the intersection between mental health and sleep using a form of the above methodology.

These studies are difficult to get right, and there are some things we should keep in mind when discussing them.

Inherent difficulties in establishing causal relationships between sleep disorders and mental health

Let’s say, hypothetically, that someone ruins their knees after years of physical activity.

They can no longer exercise and as a result, begin to suffer from sleeplessness early on. Because they can no longer exercise, they find themselves feeling less fulfilled or they gain weight, later showing signs of depression.

The knee injury preventing exercise causes first insomnia and then depression — making it appear that one causes the other whereas the injury caused both, just at different times.

One single factor that affects two different variables (independent and dependent) but isn’t controlled for in studies is called a lurking or confounding variable — something that is important to keep in mind in these chicken vs. egg questions.

Establishing the chicken and egg relationship

I can hear you screaming to get to the point, so here we go.

Depression appears to be the mental illness with the most evidence that suggests it may be caused or exacerbated by sleep disorders.

Let’s focus on this in particular.


In the Henry Ford Health Sciences Center study, young adults were brought in for an initial interview that included questions on sleep and mental health issues and returned again three years later to follow up.

The research showed that individuals who in the initial interview reported episodes of insomnia but no signs of major depression were four times as likely to develop major depression by their second interview three years later.

A more recent study, also done by the Henry Ford Health Sciences Center, employed a very similar experimental design and presented similar results. The team discovered that those expressing insomnia or insomnia-like sleep issues were again at a significantly greater risk of developing a major depressive disorder than those without sleep issues. This study specifically controlled for stressor events, age, and gender, making it extremely strong evidence for sleep disorders as a cause for depression.

Let’s throw some more evidence into the pile. Researchers in a long-term study on twins discovered that while sleep problems at age eight were a statistically significant predictor of depression by age ten, the opposite relationship was not true.

Even if we want to put our cynical hats on and reintroduce the idea of lurking variables or lack of controls into thinking about this, these studies paint a pretty clear picture that insomnia and depression have a strong causal link. While the possibility of lurking variables in this research is present, the case for insomnia as a cause or sign of major depression is becoming very compelling.


The studies on insomnia exacerbating (but not explicitly causing) depression are extremely robust as well. The aforementioned Oxford study focused on treating students presenting mental health and sleep issues for only their sleep issues through something called Cognitive Behavioral Therapy or CBT.

Though CBT intervention focused on insomnia treatment, researchers found that as insomnia symptoms decreased, so too did psychiatric symptoms like hallucinations, paranoia, and depression.

It’s also been reported that depressive individuals respond worse to treatment if they present sleep disruptions than those without, and that individuals with treated depression were more prone to relapse if they have untreated sleep disorders.

Additionally, other studies have shown that those unlucky enough to suffer both depression and insomnia as opposed to simply depression rank much higher in terms of suicidal behavior.

So can we conclude with absolute certainty that insomnia can cause depression?

Not just yet.

Let’s approach this with some level-headedness and scientific literacy.

While it appears that insomnia often precedes depression, and while treating the symptoms of insomnia can ameliorate the symptoms of depression or other mental illnesses, the studies aren’t ironclad and robust enough to come to a conclusion.

We’re close, but until we see more detailed and long-term studies, or research elucidating the biochemical or genetic foundations behind depression or insomnia, we can’t with 100% confidence conclude that sleep disorders like insomnia cause mental illness such as depression.


What we can take away from this is that we can use insomnia and other sleep disturbances as a probable early marker of depression and other mental illness, and can begin preventative or treatment steps before these mental disorders set in.

Parents who notice their children have significant sleep difficulties may want to take them in to see a mental health specialist. If you find yourself up all hours of the night, you may want to speak to a doctor about treating your sleep issues. In addition, getting information on identifying and preventing the onset of major depressive disorder symptoms could be helpful early on.

The presence of a sleep disorder could be an important red flag that something might be going wrong with your body or brain chemistry. Pay attention to it.

While research hasn’t yielded an “aha!” moment on the subject yet, we’re heading in the right direction. We’ve gotten that much closer to determining that mental illness may be developed through sleep disorders.

Some more useful information:

Our Guide to Sleep After Trauma
– The Relationship Between Depression and Insomnia
– Why Sleep is So Important to Mental Health
– Sleep & PTSD
-How Addiction Impacts Sleep 

Disclaimer this is from Mattress Advisor and contributed by Christine, a community outreach coordinator.


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Symptoms of Bipolar Disorder I

bipolar disorder pic

Bipolar disorder I has extreme highs (mania) and extreme lows (depression)


  • delusions of grandeur
  • risky behavior
  • talking rapidly
  • talking non-stop,
  •  talking about unrealistic things
  •  feeling that you are unstoppable, oftentimes
  • irritability
  • need to sleep less
  • racing thoughts
  • can’t concentrate
  • change in appetite
  • increase in activity
  • sometimes hallucinations
  • reckless behaviour
  • hypersexuality
  • more creative
  • unusual focus on religion
  • spending money excessively
  • inappropriate humor
  • europhia


  • extreme sadness
  • suicidal thoughts
  • change in appetite
  • unmotivated
  • difficulty concentrating
  • fatigue
  • decreased energy
  • feeling empty
  • feeling irritable
  • hopeless
  • anxious
  • feeling guilty
  • insomnia
  • aches and pains
  • sleep change-usually too much
  • loss of sex drive
  • thoughts of death
  • agitation
  • thinking dark thoughts
  • restless

You do not need to exhibit all of these to be diagnosed with bipolar disorder I.  However, most people with severe illness do experience most of them from time to time.

When you have bipolar disorder and cycle rapidly, it can be very discouraging to say the least.

However, there is hope out there. Therapy and medication are two examples of things that can help.





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Guest Post: A Bipolar Diagnosis is Not a Death Sentence by Carrie Cantwell

biopicI can’t believe I ever wanted to die. But then again, things right now are really good. Sometimes it’s hard to remember what it felt like to be so hopeless I was willing to end my own life. But that’s why the saying “suicide is a permanent solution to a temporary problem” makes so much sense. Just because one day, one week, even one year or more of your life is rough, that doesn’t mean things will be that way forever. Death is forever. And you can’t take it back.

I have bipolar disorder, which means I’m vulnerable to emotional stresses that can trigger a manic or depressive episode. My dad—who also had bipolar disorder—committed suicide in 1998. I remember when he started getting really sick. My senior year of college, my mom had left him. He’d been buying guns and shooting holes into the ground. He’d driven hours away to cheap motels and called her threatening suicide. He washed and dried my mom’s work suits in the washing machine, shrinking them and hanging them back up on the same hangers. I imagined little doll-sized suits wrinkled and mangled beyond recognition, and my dad—a deranged lunatic—standing over them.

I was working at my punk clothing store salesgirl job when my mom showed up to tell me my dad had just killed himself. I was numb until four years after his death, when I crashed, suffering my first major depressive episode. I felt like I was encased in a black slimy ooze that slowed my mind and body. I cried constantly. Completely unable to function, I went on disability from work. My mom (who is a therapist) sent me for a psychological evaluation and after six hours of testing, I was given a nine-page document. Laid out in black and white, there it was: I was diagnosed with bipolar II disorder. I was horrified to learn I had the same disease that killed my dad. Would I end up committing suicide too? At that moment, a bipolar diagnosis seemed like a death sentence. I started seeing a therapist and a psychiatrist. I tried antipsychotics, anticonvulsants, antidepressants and mood stabilizers. The struggle for chemical equilibrium in my brain was grueling, but I finally found a cocktail of medications that helped even out the intensity of my moods.

In 2012, I was married to a controlling, verbally abusive man. My husband had convinced me that everything wrong with our marriage was my fault. It was my second marriage and I wrongly thought I’d be a failure if I got another divorce. My self-esteem was so low I felt worthless. We were renovating our condo, and I’d been demolishing the kitchen and bathroom, hauling loads of concrete and cast iron, and meeting with dozens of contractors. It was incredibly stressful. I was agitated and irritable, and my racing mind was catastrophizing everything that went slightly awry. After a nasty argument with my husband, I took a bunch of pills with a balloon glass full of $7 gas station Merlot.

So, there I was, thirty-eight, bipolar, and trying to kill myself, just like my bipolar dad had done when he was fifty-five. What the hell was I thinking? I know what it feels like to lose someone to suicide. My mom and I have gone through so much pain because of what he did. This would destroy my mom. I was her only child. My friends and family would be devastated. But I was under the spell of mania. I wasn’t thinking about any of that.

I ended up in the emergency room, strapped to a gurney and having seizures every half hour or so. I was in and out of consciousness, being violently thrown into and out of reality as I pulled and kicked against my restraints. I was then transferred to an in-patient mental hospital. I was admitted late at night and shown to the room I’d be sharing with my just-got-out-of-jail roommate. The next two nights, I was kept awake by the all the lights constantly being on, and the schizophrenic woman down the hall. During the day, she was a kleptomaniac who stole everyone’s jeans and kept them in a pile in her closet. At night, she’d walk up and down the echoing hallway, screaming both sides of an unintelligible argument to herself. I was terrified, but I held it together and proved I was well enough to be let out after three days. I promised myself I’d never go back.

I can’t forget the look on my mom’s face in the emergency room. I’d put her through what my dad had, and even though I knew better, I did it anyway. That’s what bipolar disorder does. It makes you lose insight, narrowing your focus to a needle point, and everything and everyone else gets lost in the periphery. It’s total self-absorption.

As I began my recovery, I finally understood the gravity of my illness. This mood disorder can be fatal, if not managed properly. I’m always waiting for the other shoe to drop. I know what happens when I don’t take care of myself and give in to the voices that tell me to stay up a little later tonight or skip my meds. I need to be especially careful when something goes wrong in my life, because any little hiccup can awaken the whispering voice in my head that tells me I can escape by dying. My dad must have heard that same voice. And I don’t want to end up like he did.

I’m both a survivor and an advocate. I am currently writing a book about my experiences entitled Daddy Issues: A Memoir. I hope that by sharing my story, I can give hope to the millions of people whose lives have been affected by bipolar disorder and suicide. I have bipolar, but it doesn’t have me. I know every day with this illness is different, but I’m a pretty damned resilient person. I’ve made it through several major manic and depressive episodes, and I’ve come out on the other side. I struggle all the time, but I just do my best and try to set healthy limits for myself.

I work in the film industry as a graphic designer. I’ve always loved movies, and I feel so lucky that I get to design graphics that bring fictional worlds to life. Several years ago, I was working on a movie that had a hospital set. I was tasked with creating the logo and all the signs. While I sat at my computer, designing a large red and white emergency room sign, it hit me. If I hadn’t survived my suicide attempt, I would never have been there. My life could have ended in an emergency room. Instead, I was living my dreams doing what I love most. The horrible experience that made me want to end my own life was over. It had been temporary. Had I died, it all would have been permanent.

I’m living proof that a bipolar diagnosis is not a death sentence. I haven’t just survived, I’ve thrived. I’ve obtained two Bachelor’s Degrees in English and Graphic Design. I’ve been interviewed on NPR’s “All Things Considered” and my artwork has been published in a college art school textbook and exhibited in national and international art museums. With more than 33 movie and television credits to my name, I’ve been working in the film industry for over 13 years, earning two Emmy nominations and an Art Director’s Guild award. I also have a blog where I share my stories about living with bipolar disorder: And while I’ve had many professional achievements, I’m most proud of my recovery, my hardest-fought battle.


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Guest Post: Mental Illness and Addiction–To Have Children or Not by Adam Durnham

preview16Mental illness and addiction can figure prominently in the decision to have children or not. One’s own struggles with either or both certainly weigh heavily in the balance if there is enough presence of mind to consider the wisdom of having children or not.  Life can be overwhelmingly difficult when mental illness and addiction are unmanaged. Adding a child’s needs to the mix can exact a staggering toll on coping and emotional resources alone.

Apart from one’s own mental illness or addiction, a family history of them, even living relatives with them, can figure prominently in the decision to have children or not. Mental illness and addiction have taken a severe toll in countless families–through the generations, and often among several family members at once in a single generation.

The Trauma of Parental Mental Illness and Addiction

People who grow up in families with mental illness and/or addiction often have chronic problems including trauma symptoms, relationship difficulties, depression, anxiety and substance abuse. These issues will certainly affect their own attitudes and behaviors as parents. And, if they lived with such parental issues for a long period of time as children themselves, chances are they have what is known as Developmental Trauma which can increase the problems they will face as parents many fold.

Living with parental mental illness and/or addiction dramatically increases the risk of living with such as adverse conditions as poverty, neglect, abandonment, abuse and exposure to violence. Consequently, children in these situations are at great risk for developing a form of PTSD (Post-traumatic Stress Disorder) which is often called Developmental Trauma that can cause lifelong problems.

At minimum, in the case of unmanaged parental mental illness and addiction, children’s basic needs for emotional security, consistent support, protection, connection and guidance can go unmet. This leads to missing important developmental milestones that require a secure connection to a protective parent and having a consistently supportive environment to live in.

People with such family histories can be seriously concerned they may pass on their own childhood legacy to children of their own, and research proves their worries may be well-founded. Adults who suffered childhood adversity such as parental addiction and parental mental illness, have children who are four times more likely to have mental health problems.

Mental Illness, Heredity and Environment

We know now that mental illness can be strongly linked to heredity, so concerns about the genetic nature of such problems is reasonable when deciding whether or not to have children. Simply having lived with a parent who suffered from a mental illness is impactful enough to give one pause when thinking about having a child. Many wonder if the same will happen to them—will they become ill and cause their own children to suffer as they did, or if not, will the family illness be passed on to any children they may have.

Mental illnesses overall are believed to be caused by both inherited traits and environmental factors, but research shows clearly that some are genetically predisposed to mental health problems. This means that genetic links to mental health problems have been identified—more for some disorders than others. Among those clearly shown to have strong genetic links are schizophrenia, depression, bipolar disorder, autism, and hyperactivity disorder.

It’s common practice for healthcare providers to look for a family history of such conditions in previous generations and among siblings. Overall, people whose parents had a mental illness are at a higher risk of having one themselves at some point in their lifetimes. And, it is not only genetics that carry on a family legacy of mental health issues. Learning dysfunctional world views and coping strategies can also make one vulnerable, as can adverse living conditions caused by a suffering parent.

Addiction, Genetics and Environment

Research has shown that addiction runs in families and that many have a biological predisposition to substance problems. Those who are genetically vulnerable stand a significant chance of developing a problem if they begin substance use. In fact, research suggests that genetic factors are 50% of the risk profile for developing an addiction.

Research has found also that there is not simply an addiction gene, but that the issue is far more complex. For example, genes that affect mood can significantly play into the risk for addiction, as can genes that determine the individual metabolism of substances.  These are just two examples. To make matters even more complicated, environmental factors play a role, too.

The use of substances itself is a learned behavior. There are many realms of life in which such factors arise—family, school, social settings, community, work and the culture at large. Environmental factors such as having access to substances, and being in the company of others who use, increase the risk of use and later problems, for example. Other environmental factors that increase the risk of addiction are the attitudes of people around us socially, as well as in our families.

Addressing the Issues and Your Decision to Have Children

Certainly, many manage mental illness very well and many successfully recover from addiction. They go on to have successful lives and happy families. However, when either condition is not well managed, life in every aspect can destabilize. The ability to work, manage a home, adhere to a daily schedule, have healthy relationships, keep finances in order, carry out responsibilities and even tend to personal self-care can be seriously compromised. Dependent and vulnerable children living with parents who cannot cope with the basics of daily life suffer from neglect at best, and endangerment in the worst-case scenario.

If you are concerned about your own risks in having children who may ‘inherit’ the effects of mental illness or addiction, here are some things to ask yourself as you explore the issues in greater depth. Do you or your life partner:

  • Have a family history of mental illness and/or substance problems
  • Have primary relatives (parents, siblings) who have either problem
  • Use addictive substances
  • Have symptoms such as depression, anxiety, poor impulse control, mood swings, hallucinations, delusions, flashbacks, obsessions, compulsive behaviors
  • Have a history of growing up with unmanaged parental mental illness or active parental addiction

Naturally, these are simply starting points in anyone’s exploration. However, they are basic and significant issues. If you or your significant other is struggling with the symptoms of mental illness and/or addiction, there are effective solutions. A family legacy of struggle can be resolved in your life with the proper drug and rehab treatment center and commitment.

You do not have to ‘pass on’ the psychological and behavioral effects of your own untreated mental illness or addiction to your children, nor that of their extended family. This will not, of course, alter genetic risks, but will give you a head start in recognizing warning signs and intervening promptly if you do have children who develop problems. If you need help, reach out. Help is available.

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Guest Post: Bipolar Disorder and Substance Abuse by Sharon Torres

substance-abuse-torn-pieces-paper-450w-724878184Bipolar disorder is a condition where the person experiences dramatic changes in mood, activity, behavior, and energy. This constant shift will shape the person’s ability to live, much less perform daily tasks.

This should not be mistaken for mood swings because the effects are more severe in the sense that their ability to function is impaired.

Bipolar disorder is quite common despite the prevailing myth that it’s quite rare. This thought process is understandable considering that you may live all your life without really meeting somebody with this condition.

For instance, the National Institute on Mental Health estimates that there are almost 6 million adults, translating to about 2.6%, in the United States have this mental health issue.

Meanwhile, around 13.2 million adults or 4.4% have suffered from bipolar disorder at some point in their lives.

It should be noted, however, that not everyone with this condition could no longer function.

In fact, only about 8 in 10 people with bipolar disorder have symptoms that are so severe that their lives are seriously impaired. The rest has mild to moderate impairment or also called functional impairment, where the symptoms may have an impact on their occupational functions and social relationships.

The Uncertainty of the Severe Mood Swings

Any bipolar person will tell you that they fear the unpredictability the most.

There are three types of bipolar disorders:

Bipolar I – The person will experience a manic episode, which may be followed by depression.

Bipolar II – This is when the depression will last two weeks at the very least, then followed by a hypomanic period that can last for four days at the minimum.

Cyclothymic Disorder – These individuals are constantly suffering. They can either be depressed or manic throughout the whole year. In fact, they can count themselves lucky if they don’t experience any symptom for about two months in a year.

For people who don’t know, the depression and manic states don’t swing violently like a pendulum. In fact, the bipolar will be more often than not be depressed rather than feel euphoric.

The important thing is to get treatment. This is the only way they can reduce the symptoms. However, it’s good to know the triggers that can cause mood swings:

  1. Insomnia or sleep disturbance
  2. Stress from work or family
  3. Sudden changes in work schedules
  4. Thyroid problems
  5. Prescription medicines like corticosteroids and antidepressants
  6. Caffeine
  7. Alcohol
  8. Changes in the season

As a result, they often feel anxious and have trouble concentrating, even on very simple tasks. They act irritated and will lash out at people around them, including their loved ones. They will also lose interest even on hobbies they are passionate about. When good news is shared, it’s likely they won’t react with joy.

They will also fail to empathize when something tragic happens to a loved one or friend. Or worse, they will experience hallucinations or detachment from reality.

On the other end of the spectrum, they will have a distorted image of self-worth when they have a manic episode. They will be very talkative and even skip sleep because they are too full of energy. They will have a million ideas racing through their heads but fail to act on a single one. They would engage in risky behaviors that may have long-term repercussions to their health or finances. They would also tend to be hypersexual.

How to Cope with the Episodes:

Now that you know the triggers, you can at least anticipate if an episode is coming.

  1. Limit the amount of stress – This may be easier said than done, especially for some people who can’t stand when they lose control of the situation. Take time off from your work to travel and just enjoy life.


  1. Lay down the ground rules – It’s important that you are supported by family and friends who will offer their full support and avoid becoming stressors in your life.


  1. Talk to your superiors about a regular schedule – If there’s a rotational night shift in your office, it’s best that you are excluded from this routine. In the same vein, make sure to keep a schedule of your daily life—even the time you eat and sleep—and keep it.


  1. Sleep at the right time – If you have trouble sleeping, make sure to change your habits. Take the TV out of the room, invest in heavy curtains, play some relaxing music, and sex.


  1. Exercise – Get some sweat in. You will be surprised at how your mood will improve after a good workout.


  1. Refrain from drinking caffeinated and alcoholic drinks – Alcohol is a depressant while caffeine is a stimulant. Those substances are the last things you want in your system.

Bipolar Disorder and Substance Abuse

Speaking of substances, people with bipolar disorders are likely to also have a substance abuse problem.

According to the American Journal of Managed Care, as shared by, revealed that more than 5 in 10 of bipolar individuals have struggled with alcohol and drug addiction at least once in their lifetime.

Almost 5 in 10 of them have an alcohol abuse disorder while 4 in 10 have a drug addiction.

The relationship between bipolar disorder and substance abuse, however, is rather complicated.

Scientists have yet to map the brain to find a direct link between addiction and mental health disorder. But they are one in saying that one aggravates the other.

Bipolar disorder can be blamed on hormonal imbalance although the exact cause is unknown. There are some who suggest that this condition is inherited while others think that it’s caused by environmental factors.

The answer probably lies in between.

Looking for Answers

You can’t dismiss outright the genetic factors because a child is 30% more at risk if one of the parents has a bipolar disorder. On environmental factors, people who’ve experienced violent trauma were also diagnosed with this condition later in their lives.

In bipolar disorders, the neurotransmitters in the brain are not functioning as they should, which led to severe mood swings.  In should be noted, however, these include dopamine or serotonin.

Illicit drugs work by overstimulating the brain with dopamine or serotonin, which produces that feeling of “high.”

Researchers believe that this same action in the brain in a bipolar person is what makes him seek out alcohol or drugs.

Another reason why bipolar individuals are at risk of being addicted is their tendency to self-medicate.

The problem is that they are not even aware they have the disease in the first place. For instance, around 2 in 10 of bipolar patients are mistakenly diagnosed, which means they are not getting the right treatment.

For example, they are prescribed with anti-depressants by their primary care doctor who thought they are suffering from depression.

And as stated above, anti-depressants can trigger the severe mood swings. Instead of getting better, they are actually getting worse.

One reason why the mania is often ignored is that nobody really thinks of it as a problem compared to depression. After all, how is it a bad thing if the person is full of energy and mirth? How can you complain when during this episode you are most productive?

A 2005 study titled “Mood Disorders and Substance Use Disorder: A Complex Comorbidity” showed the glimpse of how people with bipolar disorder select the type of substance to abuse. For instance, those who are trying to cope with depression do take stimulants like cocaine.

People who have uncontrolled aggression and rage tend to abuse drugs like opiates, which can calm them down.

Alcohol is probably the common denominator, regardless of the symptoms mainly because it’s very accessible.

Treating Co-Occurring Diseases

Rehab centers like Sunshine Behavioral Health in Texas have been treating co-occurring diseases or dual diagnosis. These cases are actually more common than you think.

Dual diagnosis is a condition where the rehab patient is dealing not just with substance abuse but also with a mental disorder. The mental issue can come in many forms such as bipolar disorder, ADHD, depression, severe anxiety, and post-traumatic syndrome disorder.

Substance abuse will aggravate the mental condition in such a way that the symptoms become more severe. Bipolar patients who are genetically predisposed are especially vulnerable to this because the same chemical imbalance in their brains will be exacerbated by alcohol or drug use.

However, tracing which of the two conditions is the triggering factor is an exercise in futility. Rehab centers have a protocol of addressing the addiction first before moving on to the mental health issue.

The patient will undergo detox—which is nothing more than the procedure to manage the withdrawal symptoms—to flush out the toxins from the system. After which, the person may undergo behavioral and psychosocial therapy in the hopes of getting to the root of the addiction.

It’s important that the family should first inquire whether the rehab facility offers dual diagnosis treatment. In instances when this is not offered, the patient may be endorsed to another facility that specializes in bipolar disorder treatment.

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Depression: Steps to take to feeling better

depressionThere are five main categories to feel more vital, balanced, and free from depression.  These categories are mental care, support from people, physical care, your lifestyle, and spiritual self-care.

Mental care includes:

  • positive self-talk and beliefs
  • using a mood journal
  • being able to feel your feelings
  • working through grief
  • working with a  good therapist
  • creating a list of positive memories

People Support includes:

  • Family
  • Friends
  • Therapist/ Psychiatrist
  • Support group
  • Doing volunteer work
  • Talking to a minister/rabbi, etc
  • Peer Support groups during day treatment setting

Physical Care

  • Exercise
  • Eating nutritiously
  • Getting enough sleep
  • Drinking 8-10 glasses of water every day
  • Taking medications if necessary (and/or supplements)
  • Breathing exercises


  • Set times during the day to relax
  • Creating structure during the day
  • Setting goals (even if they are small) to feel accomplished at the end of the day
  • Fulfilling goals you have set for the day
  • Spend time outside
  • Do things you enjoy

Taking care of your spiritual needs: 

  • Have a spiritual community
  • Meditate
  • Pray
  • Forgiveness
  • Finding purpose and meaning in your life

The overall theme of all of these is to take care of yourself.  Don’t take on too much at once.  Set small goals and don’t feel like you have to do all of these things every day.  Try to do at least 5 the first day and then challenge yourself to do more and more each day.

Depression is an awful thing and oftentimes it feels like it is impossible to get out of,  but following these ideas might make it more bearable, and might even get  you out of it completely.  It doesn’t hurt to try.












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Feature Story: My Bipolar Life Story by Jason Miller

jason millerEvery one of us has the capacity to make a fundamental choice that has a huge impact on the quality of our time here on Earth: Whether we going to settle for survival or we are going to thrive. And If there is one truth I have learned over the years, it’s that human beings can thrive spiritually, regardless of material conditions and circumstances. Pain is inevitable. But existential suffering is an option.


One of my favorite theologians, CS Lewis, may have said it best:


“It would seem that Our Lord finds our desires not too strong, but too weak. We are half-hearted creatures, fooling about with drink and sex and ambition when infinite joy is offered us. Like an ignorant child who wants to go on making mud pies in a slum because he cannot imagine what is meant by the offer of a holiday at the sea. We are far too easily pleased.”

I spent many years making mud pies in a slum. And I am happy to share the story with you, as well as the way in which I made my way to the holiday by the sea. It is my fervent prayer that this testimony of a God-rendered miracle of a Phoenix rising from the ashes will provide hope and inspiration to fellow sufferers who read it.


Born in 1966 to a lower middle class American family, I grew up with all my of necessities and many of my creature comforts met. Blessed and privileged, right? Most definitely.


Health care, food, clothes, roof over my head, good education at a suburban school, Scouts, football, pets, friends, sleepovers, camp-outs, dances, some dating. All that “good stuff.”


Yet despite all this, AND despite my father’s frequent reminders that I “had the world by the ass,” I was absolutely miserable. Haunted by the belief that I “should have been happy,” there was a heaping, stinking pile of shame that came with that emotional pain.


For as long as I can remember, I had insomnia. Often I would lie awake in bed until 2 or 3 o’clock in the morning, feeling 100% certain that I was the only human being on the planet still awake. Bed-time arrived with a dose of anxiety that I would never get to sleep that night. This went on until I got into middle school.


Coupled with that, I had depression, pretty serious OCD, and some hypomania, though I hadn’t a clue what these maladies were. Much less that I even “had” them. Much like a fish doesn’t know he is swimming in water, I thought these were “normal” states of being for everyone. I just thought that everyone else was strong enough to handle them without flinching or sweating and that I was a weakling. I had no idea the water was even surrounding me and “normal” people were on dry land.


Making things even more interesting, my dysfunctional family of origin, each member of whom had their own issues, had no more of an idea what to do with me than had I been a three-headed giraffe.


My father had narcissistic, verbally and emotionally abusive tendencies. He was a bully who was very athletic, intelligent, and quite successful in business. Any time we played a game, he delighted in beating me into the ground and rubbing my nose in it, whether it was intellectual, like chess, or physical, like one-on-one basketball. This created my deeply held false core beliefs that I was incompetent and that I was weak and cowardly. One thing about my father though, in a somewhat warped way, he made me feel loved and protected. He also endowed me with a relentless persistence because no matter how many times he “beat me,” he never beat me down.


My mother has an undiagnosed personality disorder that involves empathy-deficiency, withholding love and affection, extreme self-righteousness and judging, and perfectionism. My father referred to her as the “drill sergeant” because of her rigid and demanding demeanor and way of running the house. Looking back now, I am pretty certain she was in a great deal of emotional pain from her own obsessive compulsive thinking, the demands of perfection she placed upon herself, and from enduring the verbal abuse of my father, though I rarely, if ever, recall her standing up for my brother or me when his wraith was focused upon us. Mom did instill a love of reading and learning in me and gave me a solid moral foundation (that I abandoned but later came back to) by sending me to church and Sunday school weekly with my beloved grandparents. Fortunately, it was a United Methodist Church, so I was afforded a high degree of intellectual freedom and spared the “fire and brimstone” of more conservative “evangelical” churches.


To be fair, both of my parents did the best they could with what they had, And through much spiritual effort and the power of God, I have forgiven them both. They were “hurt people hurting people who hurt.” I shudder to think what had happened to them in their youth, irregardless of who may have inflicted it upon them. They treated me as they had been treated, I am sure. And God knows I gave them plenty of Hell as I got older.


Nature abhors a vacuum, and it filled my empty and sick mind and soul with maladaptive “survival” tactics and self-medication, including checking (door locks, windows, appliances, etc), sneaking food and over-eating (my mother put me on a 1,000 calorie a day diet when I was 10 because I was 20 pounds overweight), masturbating to pornography (starting at age 11), and running excessively while seriously restricting my food intake (taking my weight from 155 to 119 with 3% body fat in 6 months). And that was just the “warm-up” before I hit 19.


I took an abnormal psychology course my sophomore year at the University of MO Kansas City and began diagnosing myself with every mental illness in our textbook. That meant, of course, that my world was coming to an end. Because having a mental illness, in my worldview, meant that I was weak, vulnerable, weird, a loser, a pariah, a failure, and destined to a life of misery, poverty, homelessness, and isolation. One particularly disturbing belief that had been espoused in my home growing up that fed my terror of “becoming mentally ill” was that war was good-because it got rid of the undesirables of society. Nothing like a doctrine of Social Darwinism to boost your sense of self-worth when you have a mental illness!


Like a fungus in a damp, dark environment, this particular obsession only grew worse. Excruciating and relentless, these intrusive thoughts plagued me and crippled me psychologically for over a year. Nasty and unstoppable ruminations of this Eagle/Valedictorian becoming an “undesirable’ were too shameful to verbalize to anyone and eventually became a self-fulfilling prophecy.


Further fueling the power of this relentless barrage of unbidden, unwanted, tortuous thoughts was the reality that because I had striven so hard to please my parents by becoming Valedictorian of my HS class and an Eagle Scout by age 14, I had neglected my social life, save for a few friends who were also academic over-achievers. By age 21, I was still a virgin and had never smoked or drank. Social anxiety and limited social skills left me paralyzed with fear at the mere thought of going to a party or any type of social event. Yup. An “undesirable” in the making. Detritus of society. Might as well have used me for cannon fodder right then and there.


Somehow, between sheer willpower, the notion that I was “supposed to live up to the only artificial standard I knew,” the best support my parents could give, and a tad bit of very weak mental health therapy, I managed to muddle through 3 miserable years of undergrad liberal arts classes at UMKC.


It was during that time that I met my first wife. And one of my big fears–that I was not equipped to take risks and leave my secure little world–began to be unmasked for the lie that it was.


My first “adventure” was getting into a physical fight with my very intimidating and much stronger father, who had always dominated me psychologically. For several months I had been standing up to him and yelling back at him. It all came to a head one Friday night as he prepared to leave for the weekend, Things got physical and we came to blows. He shouted, “you and all your shit better be out of the house by the time I get back in town.” Our fight was a draw and I moved out.


Ironically, or perhaps co-dependently, once settled into my own apartment, I wound up going to work for my father as a forklift driver and order packer. I bought a motorcycle, got a tattoo (my first of 13), started smoking, and made a “friend” who introduced me to the best’ medicines’ of my young life: alcohol and marijuana. Addiction to both were almost immediate. We drank straight, hard liquor(including Everclear) right out of the bottle and spent entire weekends hanging out and getting drunk and high. But he didn’t take me anywhere I didn’t want to go.


With all of these “social achievements” under my belt and my virginity history, I “proved” to my wicked obsession that there WAS somewhere in society that I could function. I now felt that I had found “my people.”  Others with low feelings of self worth, likely mental health issues, and a very freeing lack of giving a fuck about much of anything. And while all of this was true, and to this day those are “my people,” (though I spend the most time with those in recovery), I was still an “undesirable.”


And then I did something monumentally detrimental to the Marine Corps and to me. I enlisted. There was no war going on, so there was no need for me to enlist and no noble cause to pursue. In retrospect, I was looking to further my “social achievements” and continue to prove my demons of self-doubt “wrong.” But it was one of many decisions that became powerful opportunities for growth. (An AA euphemism for a tribulation that is often self-inflicted).


By the time I left for MCRD in San Diego, I had been smoking and drinking alcoholically for about a year. And my untreated Bipolar Disorder was in “full bloom.” Plus, my significant authority defiance issues had become very overt as my “string of conquests” grew. Though in my manic state, of which I was unaware, I gave none of these crippling conditions a moment’s thought. A. Recipe. For. Disaster.


That debacle lasted for about six months. The drill instructors could do nothing with me. Other than lame efforts at the exercises and demeaning tasks they assigned me when I defied them, their real or feigned rage and yelling motivated me to do nothing. I managed to smuggle cigarettes into the barracks, and I found that I could satisfy my alcohol cravings by buying bottles of Listerine at the PX. Imagine choking down a turpentine and using every ounce of your willpower to hold keep from retching. I sweated, choked, gagged, turned green, and ignored the aching protestations of my angry stomach, but I got my buzz.

After a few months of futile efforts to intimidate, cajole, and shame me into cooperation, the drill instructors gave up and moved me to a barracks with other miscreants for about a month. We sat on the barracks floor in front of our bunks all day with nothing to do but read the New Testament or meditate in silence. Communication was not allowed except at chow time. Two weeks later, they sent me home with the a bus ticket and a Convenience of Government Discharge. That was a happy ending. An active alcoholic with untreated Bipolar Disorder would have been nothing but a burden to them. And at that point in my life, I lacked the tools to navigate the realities of day to day civilian life, much less the rigors of the Marines.


Not long after I returned from the Marines, my future wife and I moved in together. After a year, I had quit school and started a very under-employed “career” working in machine shops. We flew to Vegas to get married, which contradicted all of her family’s beliefs and defied all their wishes. I ended up staying extremely drunk most of the time we were there and met a fellow discharged miscreant from the MCRD who supplied me with cocaine. My new wife was, to say the least, “displeased.”


Ultimately, I got a job making more money, but it was still hard, hot, dirty, dangerous work that involved a lot of heavy lifting in a sweatshop, production environment with a group of older men hardened by years of this type of labor and environment. I lasted a year and a half at this metal plating facility. (Years later, my grandfather, whom I admired greatly for his moral fortitude and unwavering perseverance in the face of tribulations told me, “Good job.” which was HIGH praise from that quiet man who was not easily impressed by people enduring in difficult circumstances). My drinking progressed to the extent that I was completely absent from our marriage and finishing off a fifth of whiskey a night when my shift ended–drinking until I passed out or blacked out. And I saw to it that the liquor supply never ran out because I drank the cheap stuff right out of the bottle. No bar tabs or $5 shots for me. $5 fifths were my vehicles to inebriation. I just wanted my medicine. No matter how bad it tasted or how isolated I was.


One day I went into work still slightly drunk/hung over and managed to fall into the 1600 gallon tank filled with 200 degree concentrated sodium hydroxide. The “cleaner” was used to strip the grease off of metal parts that we plated with zinc and was the type of a solution that the Mafia could use to make a dead body disintegrate. By a miracle of God, when I slipped on the edge of the tank, I went in feet first rather than head first and somehow emerged alive. As I desperately grabbed the lip of the tank, hoisted myself out, and flipped myself out of the near boiling lye soap and onto solid ground, the only other employee was working that night happened to be coming down the stairs. He got the hose and started dowsing me with fresh water to rinse away the chemicals that were still eating my flesh. When I removed my socks, layers of skin peeled off of my heals and ankles. My co-worker rushed me to Trinity Lutheran Hospital where they immediately threw me into a cold shower in the ER to wash away the rest of the chemical. That was one of the most unbearable 15 minutes of my life, as it felt like someone was running a blow torch up and down the chemical burns and scalding on my legs.

I had 1st, 2nd, and 3rd degree burns on 20% of my body. Hospitalized for two weeks due to the risk of infection, the pain was in excruciating, as every day they put me in a whirlpool and scrubbed the scar tissue off that would have prevented the burns from healing properly. I still cringe when I see burn victims. And both of my legs bear significant scarring to remind me of this near-death experience.


After I was released from the hospital, I had to be on bed rest at home for 3 weeks. My wife (if you are reading this, thank you) put me through a forced withdrawal of alcohol by getting rid of all the bottles in the house and refusing to supply me with a single drop. That was 1992 and I haven’t had a drink since, by God’s grace. Thanks to white-knuckling dry drunkdom and replacing alcohol with other addictions for many years. And thanks to AA since 2010. One day at a time.


Also, if you are reading this, former wife, thank you for the time that you saved our lives when I was driving drunk AND for stopping me from shooting those people in the parking lot of our apartment complex.


Without my “medicine,” all I had was Ativan and some conventional therapy that was of little help.I went back to working as a machine operator making $8/hour, performing tasks a monkey could be trained to do. Anxiety-ridden, hiding my knowledge and ability to articulate (so as to fit in with my poorly educated co-workers), and tortured to my mental and emotional limits by my obsessions, compulsions, and ruminations fed by my repetitive, solitary work, hour after hour, day after day, week after week, I was so immiserated that I began slipping down the rabbit hole of clinical depression.


Once ruminations and unwanted, unbidden thoughts take a foothold, if one has no tools to cope with them (i.e. exposure therapy or cognitive behavioral), they bedevil a person like the steady drip of Chinese water torture. They become all-consuming. They chase all other thoughts away. They wear a person out as one battles to drive them away, only to discover that the harder one fights, the stronger they become. For instance, the harder I tried not to fixate on whether or not I was going to spill the can of lubricant I used on each of the machined parts into which I was drilling the same pattern of holes for days on end was going to spill or not, the more my mind fixated on it. As if that was of tantamount importance and was the only thing that mattered in the universe These vicious ruminations became so mentally agonizing that I took to putting cigarettes out on the backs of my hands to distract myself from the mental pain and to feel the release of endorphins that comes with self-harm. The OCD component of my illness literally sucked the very marrow out of the joy of life, leaving me mentally exhausted, psychologically vulnerable, and more and more depressed. It came close to bringing me to my knees with depression and misery. Yet I fought on.


Somehow I managed to keep going, we got pregnant, and bought a house. My wife had had a kidney transplant about two years prior, so about halfway through the pregnancy, she had to go on complete bed-rest. That left us with one income. My $8 per hour. And I had re-enrolled in school in an ill-fated attempt to complete my college degree.


I will give myself credit for making a valiant effort to continue being the “hero” I had fancied myself to be when she went through her kidney transplant, but eventually, my psyche’s capacity to continue functioning with a facade of normalcy gave way and I lapsed into a severe depression. At my ex-mother-in-law’s insistence, I was hospitalized for psychiatric care. If you are reading this, thank you.


That was a nice facility covered by insurance, so there were many kind professional people and opportunities to get various types of help, with the exception of my psychiatrist. After several days (in what later would seem like a 5 star hotel), he rendered his “brilliant, highly professional and incredibly ethical opinion.” He said that I “had a had a shitty personality” and wasn’t mentally ill. While my illness probably manifested itself in shitty ways, telling a mentally ill person they are  defective rather than sick serves to starve their already anemic sense of self-worth and snuffs out nearly all hope. “Doctor,” if you are reading this, I confirmed that you bugged out to Minnesota shortly after you treated me. I pray you never got the opportunity to continue as a charlatan and harm anyone else.


Around the time of my stint in the psychiatric hospital, our beautiful twin sons had been born and were about 6 months old. The pressures of work, impending fatherhood (for which I was about as well-equipped as a school bus is to fly to the moon), school, marriage, and home-ownership converged to throw me into my first manic episode, though I didn’t recognize it as such at the time.


While in the hospital, I met a woman who had been admitted after a suicide attempt. Sick people attract sick people and we went from zero to 60 in a romance faster than the new Tesla. “Naturally” we both decided to to abandon our families (she had four children) and run off together since our spouses “didn’t understand us.” An Alcoholic with Bipolar Disorder 2 and a Bulimic with Dis-associative Disorder. A match made in Hell.


And we were hellions for most of the couple of years that we were together. We spent the first several months homeless, living with family, couch surfing with friends, and living in a weekly/hourly rate motel in a particularly rough part of the East Side of KC. Everywhere we went we managed to wear out our welcome very quickly, as we were verbally abusive vandals who stole from individuals, didn’t work, didn’t lift a finger to help others, shop-lifted, stole gas, dined and dashed (those became compulsions for me), smoked pot, carried a gun, lied constantly, and psychiatrist-hopped to get prescription self-medication.


We ended up “settling down,” getting an apartment, and getting married. And I went to work. She filed for disability for her back problems and her psychiatric diagnoses. It was a struggle, as I was under-employed and got fired frequently. We shared one beater of a car that we were fortunate to keep running. Unemployment, food stamps, thrift stores (before they were socially acceptable places to shop), Aldi (when it was the “poor store”), selling our plasma, and robbing Peter to pay Paul were all staples, as we barely scraped by.


One day I returned home and found her passed out face down on our mattress that was on the floor. I found her suicide note and an empty bottle of about 100 Clonazepam. At first I thought she was dead, but she was still breathing. This shit was real. I called 911. They sent cops, fire personnel and paramedics. There were enough emergency personnel in our little apartment to handle a three car collision. And I had a stash of pot big enough to warrant a felony shoved under a desk right next to where they were working on my wife! Doubly scary. Thank God they were able to get her to the hospital and get her stomach pumped in time to save her. And they didn’t notice the marijuana.


Everyone who was still talking to me at that time told me to leave her, but I went and saw here in the hospital anyway. We were so enmeshed that it would have been like cream trying to separate itself from coffee. And I still had that “hero” complex. We stayed together, but only lasted a few more months. Then the laugh was on me, as she moved all of her belongings out of our place while I was at work one day and I never saw here again! I was CRUSHED, but as my therapist predicted, one day I would want to thank her. If you are reading this, thank you!


Not long after her suicide attempt, I sunk into the deepest depression of my life, before or since. My mood and thoughts grew so dark that I lost all hope of ever ascending from the pit of misery. My distorted conclusion was that the shaming, negative, obsessive nature of my thought patterns doomed me to life-long suffering. AND that my parents were the root cause since they had planted the seeds during my childhood. I had grown so hopeless that the only way out, according to my twisted thinking, was to kill them and then to kill myself. I remember laying on my back in my bedroom, eyes closed, Megadeath blaring on my stereo, as I laid out my simple plan. I would go to their house that evening after Dad was home from work, get them to let me in the house on the pretext that I wanted to talk and work things out, shoot them with the gun that I had stolen from them, and then shoot myself.


Again, Divine intervention. I was seeing a therapist at the time. I had an appointment with her that afternoon. Instead of keeping my plan a secret as I had intended, I kept my appointment and ratted myself out. And she promptly had me committed to Western Missouri Mental Health.


That was three weeks of sheer misery. But it was one of the best things that has ever happened to me. It saved three lives immediately and countless others since, as I have been blessed over the last ten years to help many fellow sufferers now that I am in recovery, have had another son, and was/am a father to my twins again. God had a plan. God had a plan.


How does one describe Western Missouri? It was the state run psychiatric facility for the indigent and homeless-a Hell hole in its own right. The ONLY treatment, activity, or therapy was a 5 minute a day visit from your treating psychiatrist-who was typically an intern who spoke very broken English. The other 23 hours 55 minutes when we weren’t sleeping, those of us who were semi-rational huddled together in the day room smoking and playing cards. We were afraid. AND we were avoiding the patients who were hallucinating, strapped to their beds screaming, zombied out with Thorazine, psychotic, or, in rare cases, violent. Yes, we stigmatized our brothers and sisters I am ashamed to admit. It felt like a necessity for survival at the time though. In my prejudiced, ignorant, sheltered mind, some of the people there were quite scary.


Once I was released from Western Missouri, with my “Scared Straight” certificate, “earned” by living with and witnessing some poor souls whose mental illnesses had become so severe and chronic that they appeared to be past the point of no return, my life started to arc upward. I realized that I still had a chance and a choice.


My mother (and if you are reading this, God bless you and thank you for this and many other things) got me connected with a young therapist who SAVED MY LIFE. She believed in me as a good person who could function in society AND she introduced me to and taught me to use Cognitive Behavioral Therapy. For the first time in my life, I was not at the mercy of my rapacious shaming, negative, self-defeating, and obsessive thinking. A way out. And I took it, practicing it as hard as an Olympic hopeful. I had that powerful tool, group therapy, a diagnosis, someone who loved and believed in me, and stabilizing medication. Happiness, joy, and freedom were in sight!


That was 1994 and I was finally on a path of recovery.


Yet, that was just a beginning. And in some ways, the worst was yet to come.


In working with this wonderful woman, I used the tools and direction she gave me to become a reasonably stable, productive member of society again. I faced one of my biggest fears. I was terrified of trying to get a job that offered reasonable compensation in exchange for responsibility and intellectual challenge. And I had almost zero faith that I could articulate, problem solve, and think on my feet. So what did I do? I got a job at a collection agency as an account manager. My social anxiety, newly minted skill of asserting myself, introversion, and low self-esteem were sorely tested by the rigors and stresses of dealing with people who owed money they didn’t want to pay. Yet the pain birthed a sense of confidence AND a career for me.


At that time I was seeing my twin boys under supervised visitation at their mother’s house, but I ensured that I didn’t miss any visits. I remained single for a year and a half and continued to grow in my recovery. Yet my spirituality remained pretty stunted. I had no fellowship with others in recovery and most of my “spiritual reading” consisted of recovery authors like John Bradshaw and existentialist philosophers. With only a handful of friends and partying buddies (the ‘marijuana maintenance plan’), I was still very nihilistic and often mildly to moderately depressed.


I held that first job for a year and a half (a miracle, considering my past), started paying my child support, and began catching up on past due child support. I had a position with another collection agency within a day of losing my first job. By that time I was quite comfortable with the work and was actually ready to look for something better paying and more challenging. Yet I was still a dry drunk with all the underlying character defects. AND my Bipolar Disorder was not yet properly diagnosed or properly medicated. Marijuana, pornography, and work filled the spiritual void. My soul was still starving.


Several months into my second job with a collection agency, I met my third wife. She was over 10 years younger than me and had a two year old son. In hindsight, she was looking for a father for her son and I was looking for someone for me to rescue and to save me from my demons that still haunted me. Since there was mutual attraction, we wound up dating for a short time and then moving in together. I was a reluctant father, mostly because I lacked the confidence that I could be one. But since her son’s father was not in the picture, and due to some troubling circumstances never would be, I had no choice. A fact driven home to me by my wonderful therapist.


Initially we were poor as church mice, but as time passed, that changed. She and I both found better jobs. A commercial collections job for me and an office manager job for her. I grew into my role as a father and when our son turned seven, we had his biological father’s parental rights terminated and I adopted him. One of the best things I have ever done. Praise God.


Our relationship was good for several years. I remained stable, we co-parented well together, and she helped me in what became a protracted and bellicose custody battle over the twins from my first marriage. Unfortunately, it was long and ugly, as many of them are. It took a significant financial and emotional toll on all parties involved, including the boys. In the end, I wound up with joint legal custody and unsupervised visitation every other weekend with two weeks during the summer. My wife was an immense help in getting to that point and then carrying out the visitation. If you are reading this, thank you.


Our marriage went on for several years. The twins came over on a regular basis. We moved to a nicer area so our son could be in a good school district. I changed jobs again, landing the one where I am still working as I scribble this testimony. (Today, it’s 17 years on this job. Two promotions. One into a supervisory role. One into mid-level management that involves marketing and operations instead of collections. With God, all things are possible).


Things were going well. On the surface.


But my porn addiction became the “termites that ceaselessly devoured the foundations of the life we had built” (AA 12 Steps & 12 Traditions, Pg 49). Without going into details, suffice it to say that my obsession and compulsion became so consuming that it destroyed my relationship with my third wife. By the time I acknowledged the problem and tried to do something about it, it was too late. She had given up. And I don’t blame her a bit. If you are reading this, I am sorry.


Another broken marriage to add to the pile of wreckage in my wake.


That left me on my own again, with one pre-teen son spending every other week with me, and the pre-teen twins every other weekend. I had become cocky and complacent in my recovery-grossly underestimating the severity of my Bipolar Disorder and the effort that I needed to put forth to manage it. All this despite my porn addiction wiping out my third marriage. Continuing to feed my porn addiction was also akin to pouring gasoline on the smoldering fire of my Bipolar Disorder, which by this time was properly medicated. But as I later learned, medication alone won’t keep Bipolar in check.


This was about 2006, I had gotten involved in Leftist politics, mostly as a Blogger, and I had become a vegetarian. These sound like insignificant details, but come into play heavily later.


Another very significant thing happened around this time. I started seeing my current therapist and she finally gave me an accurate diagnosis of Bipolar Disorder 2. Previously, I had been diagnosed with Borderline Personality Disorder, Major Depression, and a couple other entries from the DSM-IV. My meds stayed the same, but we attacked it with some additional and new therapeutic tools.


Losing the stability of that long term relationship-the healthiest relationship I had ever had-sent me into a slow but momentum-gathering downward spiral with my mental health. I acted ugly in the divorce, just as I had in my first. Fortunately for all of us, there were no custody wars to leave deep emotional wounds and scars. We weren’t friendly, but the co-parenting was civil. Much credit to her. Some credit to me for learning my lesson in round one with the twins.


For the first few months, I was severely depressed. I never told anyone, but I contemplated suicide and even came close to sticking my .38 revolver in my mouth and blowing my brains out. But God had plans for me and somehow carried me through the pain. Pretty sure God was working through my therapist, a wonderful woman whom I still see regularly today. However, I still wasn’t being honest enough with her at that time for her to do much more than keep me somewhat in check and functional.


My depressive episode ran its course. And that was the start of what I later learned to be a prolonged hypo-manic episode that eventually morphed into full blown mania, followed by the inevitable horrifying train crash.


By 2008, my mania and grandiosity were hitting on all cylinders. I complied without objection when the twins told me they didn’t want to see me anymore (they were 15) and stopped exercising visitation. I did continue paying their child support, co-parenting my other son, and managed to keep my job. God only knows how. Looking back, it was those three aspects of my life that kept me from going off the rails completely.


Over the course of the next few years, I set up profiles on numerous dating sites and was constantly in a desperate and obsessive search for someone to replace wife number 4. I became a serial monogamist, jumping from one short intense relationship to another. The common theme was that, as my son would later tell me, and pardon the stigmatizing language, I was “shopping in the crazy aisle.” Which made perfect sense since I was “crazy” at that time.


Eventually I wound up with a woman who had a 14 year old daughter and a 2 year old son. We lived together for a few months, but it turns out she was a sex addict. That coupled with my porn addiction and Bipolar Disorder made the relationship, shall we say, “untenable.” It ended on a very nasty note with wicked verbal exchanges and a sucker punch from her as a lovely, parting gift.


Distanced from my parents, I developed a mentee relationship with an older gentlemen who ran a far Left website out of Connecticut and who had noticed my writings on my Blog. We struck up a relationship and he schooled me in Leftist ideology, politics, history, and causes to pursue. He also gave me life advice, which kept me relatively in-check for a time. If you are reading this, thank you for the endless hours of phone conversations, for making me your assistant editor, for your hospitality when I visited you, and for encouraging me to reconcile with my father before he died. (I did).


Unfortunately, my mania, distorted thinking, grandiosity, and vegetarianism/love of animals led me to become connected with some of the ideological leaders of the radical element of the Animal Rights Movement. My increasing radicalism and focus on Animal Rights (to the exclusion of other issues) led to the dissolution of my relationship with my mentor. Besides my job, paying child support, my therapist, and co-parenting one of my sons, my connection with him had been one of the last remnants of stability in my life.


As I was becoming more and more embedded in the Animal Rights Movement, I met a young woman on a dating site who was also a vegetarian, a huge animal lover, and an admirer of the Animal Liberation Front, the decentralized, anarchist group that uses violence as a tactic against the buildings and equipment of any industry or business that harms animals (though they have never killed anyone). We started dating. Since I had become aligned with the university professor of philosophy who underpinned and justified ALF actions through his philosophical writings and teachings AND I was a press officer for the ALF”s above-ground website that published anonymous, untraceable, encrypted communiques from ALF members who had committed an illegal action, it seemed to be a match made in heaven.


Not surprisingly, no. Turns out, she had her own mental health struggles. We ended up buying a house together and getting in way over our head financially. I had good credit and began using credit cards to pay the bills. I also began spending recklessly. Our relationship grew sour over time and she moved out for a time. She came back, but it was never quite the same.


I continued down the path of increasing mania, part of which included striking up a relationship with an Animal Rights activist in another state through Facebook. After only a few weeks, I flew to where she lived and we were married within 3 days.


Needless to say, that didn’t go over very well with my girlfriend with whom I had bought the home. When I got home with my new wife, we went by the house to get some of my things and my dog. We barely made it out of the house with Chico, my amazing companion rescue pit bull. Came up empty handed on the things. Before we could pull away from the curb, my girlfriend managed to get into the car and to start attacking my new wife. (She should have been attacking ME, but I understand her blind rage). The police had already been called by a neighbor, arrived, and broke things up before anyone got hurt. Miraculously, they let me leave with my beloved pit bull.


My wife flew back home with Chico and I moved in with my father, with whom I had had an on again, off again relationship for years. The move was necessitated by my girlfriend getting a Temporary Restraining Order against me based on false statements that I had threatened and harmed her, which barred me from entering our house. If you are reading this, I completely understand why you did it, I forgive you, and I am sorry for hurting you so deeply.


I lived with Dad for about three weeks. Despite my manic state, we were able to spend quality time together and reconcile our differences-to the extent that either of us was emotionally capable at the time. A blessing.


A good attorney was able to get the Temporary Restraining Order thrown out, as there was no factual basis for it. At the same time, that judge ordered my girlfriend to vacate the premises of our house permanently.


Meanwhile, my three week old marriage was imploding (bear in mind that I was manic-things were devolving VERY quickly). She had returned to Idaho and had Chico with her. If you are reading this, I am sorry that I hurt you deeply.


The day that I drove to St Louis to pick Chico up from the airport (my soon-to-be ex-wife flew him back to me), my father died of a massive heart attack. As much acrimony as there had been between us over the years, I didn’t think I would be that upset when he passed, but when I got the news, I bawled like a baby. A call came through on my cell phone that ID’ed as him, but when I answered, it was a police officer informing me of his death. The deeply visceral and almost primal sounds that I made were somewhere between a scream and a sob. But they shot way up the Decibel scale. God rest Dad’s soul.


In the interim, I had managed to rack up $200,000 in credit card debt; had gotten arrested for above ground non-violent Animal Rights activism; was working full time, was maintaining a widely-read Blog, was acting in my capacity as a press officer for the ALF, was co-raising my son, and was leading two major activist campaigns for an above ground Animal Rights group that I had formed in Kansas City. On top of all that, the FBI had opened a file on me to determine whether or not I was a terrorist threat (they consider the ALF to be a terrorist group) and had interviewed quite a number of people in my life, including me. 2-3 hours of sleep a night and, according to my therapist, who I still see today, I was very near a psychotic break.Yes, ladies and gentlemen, that would be a real-life example of full-blown mania


My life was a runaway locomotive, driven by an engineer intoxicated by the speed. Like Mr Toad’s Wild Ride, it was certain to end badly. But I was blind to the impending disaster.


Then suddenly, without warning, the train crashed. My feelings of invincibility, elation, and grandiosity were pulverized on impact. My mania dissipated, ebbed, burst, went away, or whatever it does. I was left feeling like a person with “normal capacity” facing the Herculean tasks that I had created for myself. I felt like the Earth had crumbled beneath my feet and I was in free-fall into a dark and bottomless abyss. I was terrified. And at the same time tormented by the chaos, turmoil, and intense pressure I had inflicted upon others and myself.


Once the mania train came to a screeching, bone-jarring halt, its nefarious twin demon, depression, reared its ugly head. It was like nothing I had experienced in my life. For a couple of agonizing months, I had a ball of anxiety-fed fire in my belly, but my overall state of being was one of complete and utter deflation with a depressed undertone. My “indomitable” will had met its match. My drive to get back up and keep fighting was gone. I wasn’t suicidal. I just didn’t feel that I had the inner strength to keep going. And to top it all off, I had isolated myself to the point that work was my only socialization and the only three people with whom I was truly connected were my therapist, my son, and my 96 year old grandfather, whom I called every night. Dark night of the soul. Rock bottom. Spiritual wilderness. Call it what you will. I was there.

   These words penned by Bill Wilson on pages 7 and 8 of the Big Book of Alcoholics Anonymous could easily have been written about my state of being at that time:

“They did not need to tell me. I knew, and almost welcomed the idea. It was a devastating blow to my  pride. I, who had thought so well of myself and my abilities, of my capacity to surmount obstacles, was cornered at last.  No words can tell of the loneliness and despair I found in that bitter morass of self-pity. Quicksand stretched around me in all directions.”


I felt spiritually dead and utterly defeated. Not knowing where to turn, I heeded the advice of an an older and wiser woman with whom I had become Facebook friends through our mutual animal activism.  She told me to go to AA “because those old men have a lot of wisdom and will help you.”


So I, who had been too proud to darken the doors of an AA hall since I “quit drinking on my own” in 1992 swallowed what “pride” I had left and metaphorically crawled on my hands and knees into an AA meeting on 9/6/2010. About 10 of the most loving, understanding, FORMER spiritual derelicts (whom AA had redeemed) welcomed me into their midst and gave me a First Step meeting. I was home. These were my people.


And so began my new life. Within a year of good sponsorship, lots of meetings, and diligently working each of the Twelve Steps of spiritual recovery (which if done in a serious manner is far from easy), I learned the meaning of the line in the Big Book, “We were reborn” as I matriculated “AA’s rugged school of life.”


Just as the Big Book so wisely discerns in “How It Works,” like all alcoholics and addicts, my life was dominated by resentment, fear, and problems related to sex. Through reading, listening, putting forth effort, practicing, and letting God do his part, I was able to begin the life-long process of rooting out these spiritual blights, identifying my character defects, praying for God to remove them, practicing their opposites, making amends to those I had harmed, forgiving those who had harmed me, engaging in daily practices that foster spiritual maintenance and growth, practicing filial love towards my fellow humans, and devoting my life to service of God and others rather than self.


All of these are happening to varying degrees at varying times in varying ways over the course of my spiritual journey. Usually I am moving forward, but sometimes I regress or get way off track, but the Higher Power of My Understanding always seems to send me a reminder, whether it be by painful consequence, through “God in Skin” (another person giving me spiritual advice), or some other means. Not wanting to return to the Hell of untreated Bipolar Disorder and/or addictions, I am typically fairly quick to respond and do what needs to be done. Healthy fear is a great motivator.


AA provided a spiritual component to my overall recovery that had been the missing piece of the puzzle for nearly two decades. For that I am eternally grateful. Had it not been for AA and the countless people in the Fellowship of AA who have helped me, i would not be alive today. Of that I am convinced. And I certainly wouldn’t have a life, as opposed to an existence of chaos, drama, self-inflicted pain, and scratching to survive


Instead, I have been blessed to be able to thrive in my job (now having held onto it for 17 years). I met an exotically beautiful, intelligent, passionate, educated woman with a strong, vibrant, and positive personality that enables her to take over a room like a force of nature. We have been happily married for several years and she has been a wonderful as a step-mother to my sons. Yup. I married up.


I have healthy friendships, in and out of the AA Fellowship, for the first time in years. I attend church (went from a raging agnostic to a believer in Jesus over 9 years) and serve others in recovery at church.


I feel comfortable in my own skin and have a good relationship with God and myself for the first time in my life. I often have an inner peace and serenity, which I RARELY had for many years.


I have been able to make amends to many whom I had harmed, and in some instances, broken relationships have been restored. And as for those to whom I have been unable to make amends yet, my spiritual way of living serves as a living amends.When and if the opportunity presents itself, I pray to be ready to make direct amends to those folks.


For the most part, I lead a sober, stable, sane, and clean life. I have more coping and recovery tools in my life today than ever before. I often help others and sometimes actually think of God and other people before I think of myself!


Today I often act rather than react. Many of the promises on Page 83 of AA’s Big Book have materialized for me. And through my personal relationship with God and efforts to live His way rather than mine, I get to reap the fruit of the spirit (Galatians 5:22-23) at times. All of these things are on a spectrum and ebb and flow of course, but the bottom line is that I have had the “Spiritual Awakening as a result of these steps.”


One last anecdote, which probably represents one of the biggest miracles of my recovery. I had been estranged from my twin sons for about ten years (from ages 15-25). It was indescribably painful, but I had recognized and taken responsibility for my part and worked through it spiritually, accepting that I might never have contact with them again. Then in July, 2016, I found out that one of my sons needed a kidney, as both of his were failing. He had been on the transplant recipient list since February. Applying my new spiritual way of life, I offered him mine via a very brief Facebook message, making it very clear that there were no strings attached and there was no expectation of a relationship or forgiveness. He accepted. I was a match. After a very extensive medical and psycho-social vetting that involved many appointments, lab tests, CT scans and the like, we went into surgery on 1/11/17. It was a success for both of us! The surgeon who extracted my kidney said it was one of the healthiest he had ever seen. Now THAT is a miracle, given how I treated my body over the years.


Today I have a strong, healthy relationship with all three of the young men with whom God blessed me as sons. In fact, the twins and I are going to see the Avengers this afternoon and to dinner tonight.  The  blessings in my life today are infinitely greater than any I could have imagined. And way beyond any that I “earned.” God’s grace flows abundantly. And doing His will instead of mine (through progress, not perfection) certainly doesn’t hurt.


I spent a good many years suffering with untreated, inadequately treated, and self-neglected Bipolar Disorder, Alcoholism, various Addictions, and maladaptive coping mechanisms. If sharing my experience, strength, and hope can spare one person even one hour of the mental and emotional Hell that I endured over the years, then I will have accomplished something very meaningful. Helping to alleviate suffering or simply comforting and offering my love and time to the suffering, particularly the mentally ill and addicts, is my life’s purpose. As forged in the crucible of my own trials and tribulations and handed to me by God. From my daily interactions with people in which I strive to be kind and helpful, to sponsorship in a 12 Step program, to serving at my church, to my vegetarianism, to giving blood and donating my kidney, to my advocacy for the mentally ill, service to others is a fundamental element of my life’s purpose and is essential to my recovery, as it gets me out of my default selfishness and self-centeredness.


Besides continuing to participate in AA and my church to maintain my spiritual fitness and growth and to be of service, I also stay mentally healthy by continuing in therapy, taking my prescribed medication, working my Cognitive Behavioral, working exposure therapy, practicing the 12 Steps and the Sermon on the Mount to the extent that I am able, building and maintaining relationships, talking to others in recovery when I am struggling, reading, praying, eating healthy, taking responsibility for my actions, seeking to practice rigorous honesty and true humility, admitting when I am wrong and making amends, and exercising. If all of that sounds like it would get tiring and difficult, it does. But what choice do I have?

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Guest Post: Interview with DJ Jaffe- Author, Mental Health Advocate, and Executive Director of

djFollowing is an interview with DJ Jaffe, author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill and executive director of Mental Illness Policy Org.

Q: What got you interested in serious mental illness?

DJ: In the 1980s, my wife and I became guardian for my sister-in-law and the day treatment program wanted to kick her out because she wouldn’t go to group therapy. I asked her why she wouldn’t go. She said everyone talked about suicide which she found depressing and it was also against her Catholic faith. In other words, she had two really good reasons for not wanting to go and for that they were going to kick her out. That made me realize how messed up the mental health system so I started volunteering with a local NAMI which at that time focused on the seriously mentally ill.

Q: What led you to write “Insane Consequences”?

jaffeDJ: I had been advocating since the 1980s and knew I had something to say: One reason the seriously mentally ill can’t get treatment is because so many mental “health” advocates (as opposed to mental “illness” advocates) shun the seriously mentally ill and don’t advocate for the services they need. Too many advocates are letting political correctness trump science. As a result of this, we now spend way too much money on mental health and not enough on the seriously ill. Anything that makes you sad is now promoted as being a ‘mental health condition’ and anything that makes you happy is now promoted as being a ‘therapy.’ Pop psychology and neuro-nonsense have run amok. I wanted to expose the trend and how to fix it.

Q: That’s a pretty big charge. How are the seriously ill shunned by mental health advocates and what’s the difference between serious mental illnesses and the others?

20% of adults have something in the DSM, but only about 4% have a really serious mental illness. There are various definitions of serious mental illness, but generally it is one that significantly impairs someone’s ability to carry out daily life activities. The serious mental illnesses tend to be, but are not exclusively, schizophrenia spectrum disorders and treatment resistant bipolar disorder. But other disorders can also be serious.

Q: How are the mental health advocates shunning them?

Here’s the issue: Many mental health advocates and advocacy organizations like NAMI National, MHA, CMHS, and the peer community want to, as Dr. Ron Pies said, “romanticize, trivialize and normalize the mentally ill.” Hence, they hide the 4% and unpleasant truths about some of them.  Here are some examples.

  • Mental health advocates generally won’t bring attention to the fact that when the most seriously ill go untreated, they are more violent than others and therefore refuse to advocate for policies like Assisted Outpatient Treatment to reduce that violence. Instead they try to convince the public of the platitude that the mentally ill are no more violent than others. That statement is true if you look at the treated. It is not true if you look at the untreated seriously mentally ill. The studies they quote show treatment works, no more no less.
  • Mental health advocates generally won’t bring attention to the fact that some seriously mentally ill need hospitals, there are not enough of them and not everyone recovers because that runs counter to their goal of convincing the public that everyone recovers and if we had more community services we wouldn’t need hospitals.
  • Mental health advocates generally refuse to focus on the fact that the biggest barriers to care for the seriously are the lack of services, doctors, clubhouses, group homes, transportation options, etc., because that runs counter to their goal of convincing the public that the biggest barrier to care is stigma.
  • Mental health advocates generally won’t focus on the fact that anosognosia, being unaware you are ill, is a real problem facing 40% of the seriously ill, because that is counter to their goal of convincing the public that everyone should be empowered to self-direct their own care.

So the seriously ill are shunned, marginalized and ostracized. They are not the poster children for recovery they want to associate with. Insane Consequences addresses these issues dead on.

Q: You’ve taken an awful lot of heat for going up against the status quo and calling government and mental health leaders out. How did you gain the confidence to do that?

I had a lot of doubts that I was smart enough or knew anything others don’t. Then I read Malcolm Gladwell’s “Outliers.” He studied super-successful people and found they had one thing in common: they all had been doing what they were successful at—whether programming computers or shooting a basketball- for at least 10,000 hours. Well since I’ve been advocating since the early 1980s, I realized I have 10,000 hours experience, so maybe I really do know something. But I still had my doubts, so I decided to write a really well-researched book, where each assertion was backed by research or government source documents so advocates could go right to the sources if they want. I give URLs for most of them. In other words, the book isn’t “DJ says such and such.” It’s what the research shows. I wrote it to give advocates the information they need to challenge the status-quo.

Q: Lot’s of advocates have written books or want to but can’t find a publisher. How did you do it?

DJ: I also thought I wouldn’t find a publisher and thought I’d have to self-publish. I didn’t think there would be a big market for Insane Consequencesbecause it is not about the 20% with any mental health condition, it is about the 4% who are seriously ill. And it is even narrower than that, because it is on policy. I jokingly described it as a very important, thick, well researched book that about ten people care about. I didn’t think a publisher would be interested. But after writing it and before self-publishing I decided to send a proposal to agents. There’s a whole process for doing that. What interested them was that I have a very large following on Facebook and Twitter and have written a lot of op-eds. To them, that was proof that my ideas have merit and there is a market for the ideas. One of the agents took the proposal to Prometheus and they published it.

Q: How’s the book doing?

I’m shocked.  It’s doing very well and is now in it’s third printing.  Advocates love it because it gives them the info they need to advocate more effectively. Many are buying copies in bulk and sending them along with a cover note to legislators and mental health officials. Libraries are stocking it. The book has led to numerous speaking engagements and a TedTalk in front of CEOs of the major mental health organizations that I criticize in my book. So I’m very happy with it.

Q You should say, that all your receipts will be donated to charity.

DJ: Thank you for that.  The Treatment Advocacy Center in Arlington, VA and Mental Illness Policy Org., will receive any proceeds I get. But publishing a wonky book for policy makers is not a money maker.

Q: How do you make money then?

DJ: I’ve lived modestly, worked hard, and don’t have kids, so I am able to support myself. Families of the seriously mentally ill who are inspired by what I’m doing make donations to Mental Illness Policy Org., a 501(c)3 I established. I take no money from government, pharmaceutical companies or any corporations at all. I have no problem speaking truth to power.

Q: Tell me about the book.

Section 1 describes the Insane Consequences of ignoring the most seriously ill: increased homelessness, suicide, victimization, perpetration, arrest, violence, imprisonment, and suffering. It gives the statistics, case histories, and documents the drain on the criminal justice system, the danger to the public and patients, and the cost to taxpayers.

Section 2 details the difference between poor mental health and serious mental illness for those new to the subject. While the boundary between the two is debatable, the extremities are clear. It describes the science of serious mental illness because policy should be driven by that science.

Section 3 introduces the major mental health organizations that fail the most seriously ill, with particular attention to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Mental Health Services (CMHS), and the nonprofits they fund. It also identifies the good guys who are trying to convince the government to treat the most seriously ill. It is important to note that since Dr. McCance Katz took over as head of SAMHSA and Paolo Del Vecchio was removed as head of CMHS, there have been improvements.

Sections 4 and 5 document exactly how the mental health industry, advocates, professional peers, and advocacy organizations prevent help from reaching the seriously mentally ill and encourage the government to waste money on programs that don’t help.

Then there are appendices on the difference between poor mental health and serious mental illness; anosognosia; violence statistics; AOT studies and HIPAA reforms.

Q: What are you hoping to accomplish?

Globally I want to focus existing mental health funds and incremental investments on those who need help the most, not the least. We have to send the most seriously ill to the head of the line, rather than jails shelters prisons and morgues. We have to prioritize, not marginalize the seriously ill. We need to support programs, like Clubhouses, that have proven track records of improving the most meaningful metrics which are rates of homelessness, arrest, incarceration, violence, suicide, and needless hospitalization of the seriously ill. Four specific policies on the federal level to help accomplish that are

First, we should eliminate the IMD Exclusion.  It prevents Medicaid from reimbursing states for seriously mentally ill adults who need long-term hospital care. It applies to no other population than the mentally ill. It’s a blatant form of government discrimination and created the hospital bed shortage. I am encouraging advocates to get their state legislatures to pass resolutions calling on Congress to eliminate it.

Secondly, we should robustly fund Assisted Outpatient Treatment (AOT). AOT allows judges to order a tiny group of the most seriously ill to comply with up to one year of treatment if they have a history of multiple arrests, incarcerations or hospitalizations as a result of not complying. It reduces homelessness, arrest, incarceration in the 70% range, an extraordinary result given that it is only for the most seriously ill. It would be great if the Centers for Medicaid and Medicare Services (CMS) made the $2,000-$5,000 court costs of AOT Medicaid reimbursable. They are essentially case management services.

Thirdly, we should expand congregate living facilities like group homes. The industry is focusing on Housing First, and scatter site subsidized apartments with drive-by case management services. That works for some, but some of the sicker wouldn’t have to live on the streets or in hospitals if there were group homes and other facilities where there is 24 hour onsite support.

Finally, we should measure meaningful outcomes and work to improve those. The most important barometers of success or failure are rates of homelessness, arrest, incarceration, suicide, and needless hospitalization of the seriously mentally ill. But no one is measuring those and holding mental health officials accountable for reducing them. Instead of useful progress measures they are tabulating useless process metrics, like number of calls to a helpline or customer satisfaction (which goes up as long as the unsatisfied leave the program).

Q: Isn’t stigma a big issue?

DJ: Stigma a non-issue.  First of all, there is no stigma. Mental illness is a no-fault biologically based disorder. We should stop teaching there is stigma and start teaching there is none. There is discrimination. And eliminating discrimination is where we should focus. Gays, African-Americans, rape victims, people with cancer all used to claim stigma and got nowhere. Then they decided to fight discrimination. Gays fought for the right to marry, African Americans for the right to vote, rape victims for victim’s rights, and cancer survivors for more research. It is only the mental health advocates who are still making stigma, rather than discrimination their focus. They give plaques to mayors who say they are against stigma at the same time those mayors are discriminating by refusing to build group homes. The homeless guy eating out of a dumpster and the delusional son, cowering in his room are not doing so because of stigma, they’re doing so because there are no services for them. Stigma is the black hole of advocacy diverting thousands of people away from making real change.

Q: If not stigma, what should people work on?

There are scores of issues to work on. I tell advocates to work on whatever they are passionate about (other than stigma) but to go deep. Become the expert. It is not enough to say there is no housing, no transportation, no clubhouses, no easy access to hospitals. You have to identify why that is so, what level of government can fix it, and how to bring pressure on it to do so. Go deep.

Q Where are you focusing your advocacy right now?

I lost my wife of 27 years recently after a long illness so during that period I scaled back my work, and cancelled speeches, but I am back up and running full speed ahead. The biggest thing taking up my time is giving speeches designed to seed the theme developed in my book, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. If anyone wants me to address their group, they can reach me via our website.

 Q: Finally, How’s your sister in law doing?

DJ: Thanks for asking. She lived in a group home for many years where she gained the skills to eventually live independently. She lives in her own apartment, supported by the county but as her closest relative, I supplement that by arranging additional services. It’s working, but it’s tenuous. I give her a great deal of credit and she is the inspiration for everything I do. In addition to Dr. Torrey and my wife, the book was dedicated to her.

More info

Buy Insane Consequences on Amazon

Mental Illness Policy Org webpage

The Mental Illness Policy Org Facebook Page

Our National Alliance on Serious Mental Illness Facebook Group

Mental Illness Policy Org on Twitter

Ted Talk

Follow us on Facebook
Follow us on Twitter (@MentalIllPolicy)
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