Bipolar Expeditions Read Free Page B

People on the other side of the line did not have just ordinary foibles and weaknesses: they needed an alliance with psychiatrists who could “know” and manage their illness.
    What is it like to have a disorder where you are energized when you don’t want to be, where your idle is too high, and then where you come close to despair for reasons that are not clear? You know that eventually you will get a combination of three or four meds that will work for you. But what is different about manic depression is that it is always changing over time. Unlike depression where you only need to step on the gas, manic depression needs both brakes and gas.
    Up to this point, Nemeroff had been speaking in a way that included the people living under the description of manic depression who were present in his audience. In the next few sentences, he made abrupt shifts that excluded them, included them, and then excluded them again. Excluding: “Too often the plunge has already happened when we [doctors] are trying to manage it.” Including: “So you need a health care ally.” And then excluding again: “My family is used to patients calling all the damn time. How else can you take care of these people? We need the understanding that they may have a fuller cup when well [i.e., they may operate at a higher level] than most people. So the stakes are higher in treating them.” He asserted that people on the other side of the line needed to have drugs residing inside them to achieve even a modicum of rational self-monitoring.
    When drugs are well established, a partnership can be established, in which the patient is granted partial and temporary control over himself. Self-knowledge is critical and this is why therapy is moving into psychological education. Knowledge is power! These meetings are for that purpose: not to help doctors dictate to patients from on high, but to help patients collaborate with their providers. They are to facilitate self-control and self-actualization. I try to move quickly to ways patients can even adjust their own dose of medications—for example, high-powered attorneys who have to try a case in court might want to have less medication onboard that day. If I have worked with them long enough and have trust in them, they can be in control of their medications for that day. This enhances their sense of control.
    Dr. Nemeroff was speaking to an audience that included a good mix of physicians, patients, and patient advocates, so it is no wonder his point of view shifted. That he could shift between himself and his manicdepressive patients so frequently indicates the line may be easier to move than we think.
    The two patient advocacy organizations I studied, which were to varying degrees run by people with the diagnosis of manic depression, provided rich ground for considering whether people assigned to the “irrational” space of mental illness were thought to be capable of managing their own or others’ behavior. In both organizations, the facilitators of weekly support groups were self-selected members who underwent specific training provided by the organization. I took the elaborate course of training offered in Baltimore during my fieldwork. In the training sessions, there was often explicit commentary on the unruliness of manic depressives, their need—at times—for management by others. From a leader (with the diagnosis of manic depression) who had come back for a refresher course:
    I have learned over time. It used to be total chaos, more than one person talking at a time, and there I am not doing anything about it, or it’s all jokes and then all of a sudden someone is crying. You get three or four manics at one time. I will tell you the whole skill of moderating is get the manics to shut up and the depressives to talk, but they censored me on this! If you are manic, you gotta shut up, because if you are manic you can’t shut yourself up.
    This