Why the Hell Did I Wake Up at 2 A.M.?

Basic to the management of bipolar disorder is what health professionals call "good sleep hygiene." This consists not only of getting enough sleep but of observing habits that maximize the chances of getting a good night's sleep. Although I consider this a critical skill, I've found it difficult to master, and some of the things that work for me run counter to the usual advice. For instance, it's recommended that one not watch television before retiring and above all that one should not sleep with the television on. Television, observes the Sleep Disorders Center at the University of Maryland, "is a very engaging medium that tends to keep people up."

At the same time, the Center advises the aspiring sleeper to "leave your worries about job, school, daily life, etc., behind when you go to bed." In my experience, this has proven almost impossible. From childhood I've nearly always lain awake for at least an hour, worrying about this or that. A solution that has worked for me is a modification of the "no television" rule. I leave the TV on, but I have it play a DVD that I practically know by heart. It distracts me from worrisome topics and because I'm thoroughly familiar with the story line, it doesn't engage me enough to keep me awake.

Some DVDs work better than others. The most reliable, oddly enough, is a war movie, Twelve O'Clock High, I think because it consists mainly of dialogue and has almost no combat scenes.

Still, my sleep pattern tends to oscillate between a lot of sleep -- last week I found myself sleeping as many as twelve hours -- and comparatively little, generally only four hours a night. Last night was an extreme example. I slept only ninety minutes and awoke with the certainty that I would not be able to get back to sleep. In such instances the advice is not to force sleep but to read quietly or maybe take a warm bath. In no case should one do office work, housework, etc. This is a rule I nearly always violate, because once again it doesn't work for me. I have found it more effective to push through the day and then retire at an early hour but not too early -- say at 9 p.m. This usually results in getting sufficient sleep the next night, and I'll take an Ambien to try and make sure of it.

Although I don't become alarmed when I get too little sleep, I do start looking for signs of a potential hypomanic episode. As a checklist I use the relevant criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, which I have more or less memorized (and also own a copy).

The first question I ask myself is whether I feel refreshed, as if I had gotten a full night's sleep. That would be bad. Fortunately on this occasion I don't feel that way. I feel functional but kind of tired, and were it not for the proscription against taking naps during the day, that's probably what I'd wind up doing. (I sometimes take cat naps anyway. Even twenty minutes can restore a measure of vitality without compromising my ability to get to sleep that evening.)

Second, I ask myself whether I feel unusually creative and raring to go. Again, that would be bad.

Third, I look at whether I am easily distracted, which is another symptom of hypomania. If I can stay on task, whether it's doing dishes or paying bills, I'm less concerned.

Lastly, if the condition persists for four days, then getting a good night's rest becomes an absolute priority, and on such occasions my psychiatrist has authorized me to double the dosage of Ambien. This generally does the trick.

There are other criteria indicative of a hypomanic episode -- e.g., an unequivocal change in functioning uncharacteristic of the person when not symptomatic, and the disturbance in mood and functioning are observable to others -- but I seldom find evidence of the former and as for the latter, I am continually amazed by how rarely anyone picks up on a change in my mood and / or functioning, at least not on the "high" side of normal. Depressions, my principal bête noire, are more noticeable to friends, though not to colleagues (or if they do notice they rarely say a word).

In any event, the object is to avoid as many symptoms of a hypomanic episode as possible. And one thing I definitely avoid is the temptation to "ride the wave" of increased creativity that often characterizes a hypomanic episode. I have heard of writers, artists, etc. who firmly believe their creativity is inextricably bound to their hypomanic episodes and therefore resist treatment. I say the hell with that.

Meds - Pt 2

Every evening I take between three and six pills --invariably two of Lamictal and one of Zocor (a cholesterol-lowering drug), to which I often add one or two Klonopin and occasionally one Ambien.

Even after all these years, I still find this a little strange. From an early age I disliked the very idea of taking anything stronger than the occasional aspirin or cold medication. I didn't begin taking psychotropic medications on a consistent basis until my mid-thirties, and I somehow doubt I will ever get used to it. I've just learned to accept it as a fact of life.

Little in my civilian background equipped me to deal with bipolar disorder. Within my family a taint of shame and weakness, usually covert but hard to miss, attached to it with regard to my mother. It was not much different when I was diagnosed in 1986. Most of my friends just sort of fell away, as if my life were over and I was no longer worth the investment. Many years later, when my life was on track and the bipolar disorder obviously in hand, I became reacquainted with one of these friends and asked what had happened. "We just didn't know what to do," she replied. Which was slightly odd coming from a devout Christian as well as a registered nurse.

Within academe scarcely anyone ever inquires about the disorder. I think it makes them feel awkward. And as I've written elsewhere, a common reaction is to consider it "inappropriate" for me to openly discuss it. Almost no one has said this outright, but an academic generally has a lousy poker face. Over the years it has been increasingly difficult to find a plausible alternative explanation. And of course I live in a society that still prefers to see mental illness as a character disorder ("Snap out of it!") or as an all or nothing proposition (you're either normal or you're abnormal).

Almost the only thing that has equipped me to handle the disorder is my experience with the Army. Back in basic training the Army drilled into me a vital core principle: You do what it takes to accomplish the mission. The aesthetics don't matter. You don't need to look like John Wayne. A manly attitude is irrelevant if it doesn't translate into effective action. It doesn't matter what other people think. The mission is everything.

A second thing the Army did for me -- as it does for most recruits -- is to show you that you are stronger than you think you are.

Even so, the need to be "normal," to be like everyone else, is powerful, particularly in young people who have not yet realized that no one is normal, that no one is like anybody else, and that we all carry wounds. Initially I took medications -- lithium and Imiprimine (an early antidepressant) -- for perhaps nine months, and even then without much conviction in their efficacy. It was tough on me psychologically. Taking the pills always seemed like a bizarre eucharist, a daily acknowledgment that I was now as broken as my mother had been.

Then for over ten years I took nothing. It took not only a brush with an unmistakable hypomanic episode to bring me to my senses. It also took the maturity that comes with being older and the basic confidence that comes with having securely established myself in life.

To my surprise, the first psychiatrist I consulted prescribed nothing stronger than a sedative to help me sleep. "You've had the disorder for eleven years," he pointed out, "and during that time you've gone to graduate school, gotten your PhD, succeeded in getting a faculty position, published a prize winning book, and gotten tenure a year early. Clearly you've been able to manage the disorder. So until I know more I'm not in a big hurry to put you on psychotropic medications."

Within a couple of months, however, the hypomanic episode had been succeeded by a depressive episode that seemed unrelated to anything in my day to day life and was sufficiently debilitating that it became difficult -- though not impossible -- to function normally. Certainly, though, I could not function at my usual level and on top of that, life seemed flat and meaningless. Small reversals suddenly loomed large. The memory of old failures and regrets constantly tugged at my thoughts.

So I consulted a second psychiatrist -- not because I disliked the first but because the second one was in my health care network. The first had not been. I wanted an antidepressant but I knew enough to recognize that an antidepressant alone carried the strong risk of vaulting me into a manic episode. Consequently I would have to take lithium as well.

In July 1999 -- precisely ten years ago, come to think of it -- I had a manic episode that simply blew through the lithium, and when the second psychiatrist somehow refused to accept this fact, I got rid of him and found the psychiatrist I continue to see to this day. I'll call her Jennifer -- it's hard to call her "Doctor" since we both have doctorates, although mine is merely PhD. Jennifer put me on depakote, which worked fine except that, as I mentioned in Part 1, it had the effect of ratcheting up my weight. When I discontinued it, I was startled by how rapidly my weight returned to normal.

As I indicated earlier, we substituted Lamictal and gave it the dual role of antidepressant and prophylactic against mania. But in the depakote years we tried and discarded any number of antidepressants after experimenting with different dosages of each over a period of months. There were so many I can't recall them all. Looking over a list of antidepressants, however, I recognize at least four: Celexa, Lexapro, Effexor and Wellbutrin. I'd bet money there were at least one or two others. [Update: Seroquel and Neurontin, though in both cases quite briefly.]

None of them, as far as I could tell, worked worth a damn. We finally hit upon Lamictal (even when I was on depakote). Lamictal is interesting in that you start with a negligible dose and it takes over a month to gradually ramp up to therapeutic levels. That's because in rare instances it has an undesirable side effect, namely a severe, life-threatening rash that from descriptions sounds practically like spontaneous combustion.

Fortunately I had no problems with it. It seemed to mitigate, though it did not eliminate, the depressions, and gradually we came to suspect that the depressions were often triggered and / or exacerbated by environmental factors, of which (perhaps) more in a future post. This past spring, however, although I was here at the Army War College, an environment in which I have thrived, I experienced a series of depressions in which the reprieves were so fleeting it was basically a single continuous depression lasting almost three months. We responded by doubling the Lamictal (from 100 to 200 mg per day). I've been fine since then.

Part 1 - Part 2

Meds - Pt 1

These are the medications on which I rely to manage Bipolar Disorder. (The generic name for each medication is given in parentheses.) Because the disorder varies in intensity from one person to another, and because each person's biochemistry is unique, what works for me would not necessarily work for someone else.

Main line of defense: Lamictal. Has anti-manic and anti-depressant properties. Basic tool for combating the disorder.

Close support: Klonopin. Mood stabilizer. Comes in handy for mitigating serious depressions and anxiety attacks. Also has some sedative properties.

Reserve support: Ambien. Used occasionally when it seems likely I will not otherwise get enough sleep.

Discontinued: Depakote. Along with lithium, the standard prophylactic against mania. But even at low doses usually results in weight gain -- in my case as much as thirty pounds -- and given the history of heart disease in my family and the conscientious way in which I have addressed the disorder, my psychiatrist and I decided two years ago to rely exclusively on Lamictal coupled with good sleep hygiene. Has worked well: no hypomanic episodes during that period.

Part 1 - Part 2

Room 101 - Pt 3

People with bipolar disorder almost invariably have a psychiatrist, who prescribes their medications. Frequently they also have a therapist -- in my case a clinical psychologist whom I'll call Laura. Laura's office is typical of most. It is comfortably furnished. It is uncluttered. Its walls are light in color and the few prints and photographs on those walls are light in tone. Sunlight pours in through large picture windows. All in all, the room seems cheerful, reassuring, and safe.

In many ways that impression is accurate enough. Laura is good at her job and I have always felt as if I were in safe hands.

In one key respect that impression is wrong. Decidedly wrong.

The worst thing in the world is in that room.

As in Nineteen Eighty-four, the worst thing varies from individual to individual. And as in Ninety Eighty-four, the interlocutor often knows what it is, if not in the early sessions then usually after a few months. That's because although each person is ultimately unique, the symptomology falls into broad patterns that offer an experienced therapist -- O'Brien, to pursue the analogy -- solid clues as to the likely underlying problem. Certain patterns, for instance, are common to adult children of alcoholics. Others are common to persons with borderline personality disorder, still others to persons who have been sexually abused.

The worst thing, however, is seldom evident to the client, because they have spent most of their lives excluding it from their awareness. The techniques of exclusion have usually taken the form of the very attitudes and behaviors that eventually bring them to the therapist's office in the first place. As Carl Jung once explained, "People will do anything, no matter how absurd, in order to avoid facing their own soul." Or more famously: "Neurosis is always a substitute for legitimate suffering."

And yet, when finally confronted with the worst thing in the world, the client is seldom surprised. Because in order to avoid a thing they must, at a a semi- or subconscious level, have an idea of what that something is. They know that they have been, all along, on a journey to discovering what specifically is in Room 101. But unlike Winston Smith, they have usually entered Room 101 by choice.

They have done so notwithstanding the stigma attached to psychotherapy. It is common to hear people pour scorn upon psychotherapy or uncritically accept the crudest caricatures of it. Upon encountering someone like myself, who no longer minds saying that he sees a therapist, their attitude is at best one of incuriosity.

In their disdain the scoffers are powerfully abetted by ubiquitous media images of therapy. In the culture wars it is common to hear of a "therapeutic society" that promotes victimhood and diminishes individual responsibility -- it is no accident that blaming one's parents is thought to be the alpha and omega of therapy. In commercials the therapist is usually portrayed as an eccentric disciple of Freud, distant and detached, scribbling on a pad of paper while the client, recumbent on the proverbial couch, says all sorts of wacky things. On television the therapist character is often brought in to deal with someone accused of a serious crime or whose behavior, at the very least, is utterly bizarre. (Favorable depictions of therapy, by the way, are almost equally unrealistic.)

If the suggestion is made that therapy might be helpful to them, the scoffers rule it out of bounds, even when the presenting problem -- a marriage that is failing, an uncontrolled temper that is wreaking havoc on their personal or professional lives -- is screamingly obvious.

These are people who have not made an informed or reasoned decision about therapy. Their choice comes from their gut. They understand instinctively that the worst thing in the world is in the therapist's office, and no way in hell are they going there.

Part 1 - Part 2 - Part 3

Room 101 - Pt 2

“You asked me once,” said O’Brien, “what was in Room 101. I told you that you knew the answer already. Everyone knows it. The thing that is in Room 101 is the worst thing in the world.”

The door opened again. A guard came in, carrying something made of wire, a box or basket of some kind. He set it down on the further table. Because of the position in which O’Brien was standing, Winston could not see what the thing was.

“The worst thing in the world,” said O’Brien, “varies from individual to individual. It may be burial alive, or death by fire, or by drowning, or by impalement, or fifty other deaths. There are cases where it is some quite trivial thing, not even fatal.”

– George Orwell, 1984, Book III, ch. 5

Part 1 - Part 2 - Part 3

Room 101 - Pt 1

Winston lay silent. His breast rose and fell a little faster. He still had not asked the question that had come into his mind the first. He had got to ask it, and yet it was as though his tongue would not utter it. There was a trace of amusement in O’Brien’s face. Even his spectacles seemed to wear an ironical gleam. He knows, thought Winston suddenly, he knows what I am going to ask! At the thought the words burst out of him:

“What is in Room 101?”

The expression on O’Brien’s face did not change. He answered drily:

“You know what is in Room 101, Winston. Everyone knows what is in Room 101.”

– George Orwell, 1984. Book III, ch. 2

Part 1 - Part 2 - Part 3

Stones of Memory - Pt 2

Originally published, in slightly different form, on Blog Them Out of the Stone Age in August 2005

This is a post I've been reluctant to write. But except for me, the people principally involved have long since passed away, and what happened to us was no different than what happens to thousands of families each year.

Five days before Christmas, 1974, my father suffered a heart attack. He was barely forty years old. The day after Christmas my mother summoned me into her room and told me that my father wanted to leave the marriage. There were a number of reasons he wanted to do that, and there's no need to review them here. I think that fundamentally it had hit home to him that he had only one life and he wanted to grab for happiness while he still could.

My mother did not know what to do. She seemed lost. She asked me for my advice. She was very serious about it. I knew nothing about marriage or relationships so I drew upon the one thing I did know something about, which was war. I had been steeped for years in military history. It seemed to me instinctively that this situation -- Dad wanting to leave the marriage -- was like a kind of war. Mom was wondering about how she might plead with Dad to stay. I told her flatly that the best thing to do was to give him an ultimatum: that he either had to agree to marriage counseling or leave the marriage, and that she should start finding herself a lawyer.

The whole idea ran counter to Mom's instincts, which were to try to do something that would win him back. But she was so benumbed by the situation that she decided to take my advice. It worked. My father, shocked at the sudden reversal of momentum, agreed to enter marriage counseling. I wish I could say that things improved between them, but they never did. Eventually they divorced, but not for another eight years.

When I advised my mother to confront my father with an ultimatum, I was operating on a strategic principle I had learned from Robert E. Lee: In war you do not let the enemy keep the initiative if you can possibly help it. It was not until my late 30s that I finally understood why the strategy worked. I found the explanation in a book by sociologist Diane Vaughan entitled Uncoupling: Turning Points in Intimate Relationships (1986). On the basis of interviews with 103 people, Vaughan argues that relationships tend to end according to a certain pattern. It begins with a secret -- one member of the couple is dissatisfied with the relationship, but keeps it to herself or himself to avoid rocking the boat, or because the level of their dissatisfaction is not yet apparent even to them. Eventually the discontent comes into the open and larger confrontations ensue -- but still within the context of an on-going relationship. Finally the dissatisfied person announces that they wish to leave. Vaughan calls this person the "initiator," and her analysis indicates that they hold most of the cards.

Often, however, the initiator's desire to leave comes out before they have completed the financial and psychological preparations for abandoning the relationship. Their problem is eased by the fact that the partner -- the person who wants the relationship to continue -- makes desperate efforts to save the relationship. The partner may respond by trying to change themselves so as to become someone the initiator can again love. They may make concessions of other sorts. They may agree to a trial separation, which in their minds is an effort to save the relationship but to the initiator simply reduces the social costs of moving out, while supplying the comfort of knowing that until their preparations are finished, they always have the option of coming back.

The initiator's advantage is so pronounced that Vaughan devotes 13 pages -- an entire chapter -- to explicating it. Mostly the advantage turns on the fact that the initiator has already had lots of time to prepare for the break, and that the partner tends to supply whatever additional time is needed through various efforts to save the relationship. The solution, strategically, is for the partner to make no effort at all to save the relationship; on the contrary, to push toward an end to it at the earliest possible moment. Either one of two things will happen. The erstwhile initiator will be confronted with an end to the relationship before their financial and psychological preparations are complete, and, shaken, may try to return to the relationship. Or the partner gets the break-up over with as quickly as possible.

My ultimate point is that war turns out to be a dynamic that applies, metaphorically, to many other areas of life. And if a = b, then it follows that b = a. Other areas of life apply metaphorically to war. Thinking about the options faced by a small kid having to deal with a playground bully can deepen our understanding of war, because it forces us to think in fresh ways. So can thinking about the conflicts within a relationship. The single most interesting review of The Hard Hand of War was offered by my sister. She said it was an allegory of our parents' marriage.

Manic Depression Didn’t Kill Your Dog

For the past couple of days I've dipped into blogs maintained by people with bipolar disorder and, as I've done so, have constantly tinkered with the blogroll. Blogrolls become useless if the lists are indiscriminate (which most of them are). I try to limit mine to ten or twelve. I just added ... salted lithium, which is maintained by "Gabriel," a Canadian journalist who describes himself as being in his fourth year of recovery after eighteen years of dealing with undiagnosed bipolar disorder, which he prefers to call by its traditional name, manic depression. It's one of the better blogs I've read so far. This is one of the better posts:

Manic Depression didn’t kill your dog. Manic depression didn’t rape you. Manic Depression never picked up a gun. People are not their cancer and you are not “A Manic Depressive”, you “Have manic depression”.

You are not your disease. It’s a trap that we all fall into eventually. After I was diagnosed I was “A Manic Depressive” for the better part of eighteen years. Being “A Manic Depressive” gave me excuses that could easily explain why I was who I was. I would tell people “I am A Manic Depressive” and they’d be uncomfortable for a little while and that was it. The reaction was there was no reaction because people have no idea what A Manic Depressive does, or have any idea what Manic Depression does to us.

But it was an excuse I could offer — from one ignorant to another, and it worked because calling yourself “A Manic Depressive” or “A BiPolar” sounds like it should mean something Important. Unlike most diseases manic depression has been romanticized, captured in paint and in song, so people — including us — do not fear manic depression. So the people around us do not fear for us. So the people who care about us, the people who care for us, just shrug their shoulders and give no reaction because those people have no idea what manic depression even means… because I had no idea what manic depression meant for the first eighteen years.

For too long we’ve deluded ourselves into believing manic depression was either something to be perversely proud of or something to be desperately ashamed of… but the mystique is a lie, it’s just a fucking disease. Why do we have such a hard time convincing ourselves and others about the horrible effects this disease has on us when there are a million fucking web sites and blogs about Manic Depression and every Pharmaceutical company sells an anti-depressant or a mood stabilizer, and there’s certainly no shortage of websites dedicated to selling the pills or telling us why those pills are evil… so, with all of this information so available, why is this disease so misunderstood?

Full post

Patient Voices: Bipolar Disorder

From the New York Times, July 16, 2008

"What is it like to have bipolar disorder? To be labeled 'crazy'? How do you balance the ups and downs? Here, in their own words, are the stories of nine men and women living with bipolar disorder." A series of audio clips of about 2 minutes each. Poignant, perceptive, illuminating, and very much worth a listen.

(Hat tip to Heather Soyka)

Stones of Memory - Pt 1

Abridged and slightly revised from an account I wrote some years ago.

My early life was dominated by two events that occurred before I was born. I knew nothing of them until I was nine or ten years old. I know little about them even today. I suppose I could investigate, but the precise details don’t matter much. What matters is that these two events decisively, elementally shaped the battlefield on which my life has been fought, and they were all the more powerful for being glimpsed only intermittently. Strategists speak of a “fog of war.” Personal lives are subject to much the same thing.

The first event: In 1937 a foolish young man decided to make some easy cash by counterfeiting fifty cent pieces in his native eastern North Carolina town. He was caught, tried, sent to jail. His wife could not afford to keep their brood of children, so she farmed them out to friends and relatives. My father, then three years old, had been known to toddle behind a certain milkman on his daily rounds. The milkman and his wife had recently lost a child to illness and so decided to take my father in when the chance arose. (They did not formally adopt him until many years later) My father knew that in a material sense his life was better as a result, but he could never understand how his own mother could give him away like that. Particularly since within a few years his siblings were folded back into his biological family and he was not. I know this only second hand; I never heard him speak of it.

The second event: In 1958, a tortured wife and mother of five, once beautiful but slipping into middle age, bright and gifted but thwarted and unappreciated by a limited, sometimes abusive husband, put a revolver in her mouth and pulled the trigger. She did it during the day while the house was empty: her husband at work, her children at school. The husband usually came home for lunch and undoubtedly she expected that it would be he who discovered her body. Instead it was her youngest daughter, thirteen years old. She had forgotten her school lunch money and come home to retrieve it. The scream that filled the house that day never left it.

The woman who killed herself was my maternal grandmother. From the little I know of her I think she had bipolar disorder, though the young daughter, who grew up to be a registered nurse, thinks it was more likely schizophrenia.

My parents at that point had been married less than a year. They had met in January 1958 and were married four months later. They had little business sharing a cab, much less a marriage, but for better or worse they stayed together for almost twenty-five years.

Ten months later I came into the world. For the first five years of my life that world seemed warm and safe and happy, and my two parents seemed the best and most beautiful people in the world. In point of fact, they were good-looking. My father was slim, knew how to dress and carry himself, and had an infectious grin that managed simultaneously to be both boyish and masculine. My mother was a local belle who had once won a beauty pageant sponsored by a Norfolk television station. Among her prizes was an all-expenses paid trip to New York. A fashion photographer trailed around her, snapping pictures of a poised young woman who believed she had a great future ahead of her. I still have the photos. I almost never look at them.

Because her family had money and position in the rural North Carolina county in which she grew up, and because she had graduated second in her high school class, my mother went to college at Duke University. But her high school served a community of five hundred residents, her graduating class numbered exactly twelve, and she was not prepared for Duke. Overwhelmed, she left after a semester or two and went to a safer, less challenging school. Later in life she called that decision one of her greatest regrets. She went first to her mother’s alma mater, Guilford College, and then transferred to East Carolina College (now University) in Greenville. There she met my father.

My father hailed from New Bern, a town on the Neuse River not forty miles from Greenville, but he came to East Carolina by way of San Diego, Tokyo, and other ports of call on the Pacific rim. After graduating from high school in 1953 he had joined the U.S. Navy and served aboard a destroyer escort. He credited the experience with turning his life around. In high school he had not been a serious student. He ran with the popular crowd and played football but did not apply himself. It galled him, however, to take orders from ensigns just a few years older than himself. He once told a particularly obnoxious ensign, “The only difference between you and me is that you have a college degree and I don’t.” He began buying books to broaden himself, and when he got out of the Navy in 1957 he entered East Carolina.

My parents lived in Greenville until they graduated, then moved to a town not far away. Both became teachers: Mom taught Home Economics and Dad taught English. But they quit soon after my birth, she in order to be a full-time mother and he in order to take a better paying job. He found it working as an underwriter for an insurance company in Raleigh. He worked for that company for the rest of his life. He fell into the job almost by sheer chance; it was not something he chose to do. He spent most of every year working hard at a job he did not particularly like so that he could support his family. To reconcile himself to this fate, he convinced himself that when you’re an adult, your dreams have to die, and that maturity consists of accepting this hard reality.

My first memory is of my parents’ apartment in Raleigh and of my father riding me on his shoulders across a dirt road a few yards distant, so that I could see the excavators and tractors that were constructing the belt line around Raleigh. I can also remember our move to a modest ranch house in the suburbs. By then my brother had been born, followed three years later by my sister.

Shortly after my sister's birth, Mom had her first manic episode. It was really pretty florid, with delusions that her dead mother was Christ and that she herself was the Virgin Mary. Her doctors thought it was schizophrenia (in those days a common misdiagnosis). She was hospitalized for three months. During that time Dad sent my brother and me to stay with our paternal grandparents.

In June 1968 the family moved from the ranch house to a Cape Cod not far from the campus of North Carolina State University. Mom thought the move would revitalize our family life -- by which she meant her life -- because her marriage to Dad was getting pretty barren. We lived there less than a year. Then my father accepted a promotion and transfer to Lynchburg, Virginia. Shortly after we moved -- the boxes containing our belongings had not yet been unpacked -- Mom had a second manic episode. My father had to scramble to locate a hospital and a new psychiatrist for her. It was at this time -- I was then just shy of my tenth birthday -- that Dad decided to tell me that Mom had a mental illness. The point of telling me was to secure my help around the house and with my two younger siblings. From then on I functioned as a deputy parent, not continuously but more or less in accordance with my parents’ whim. I wasn't much good at it. Certainly my parents didn't think so.

If Dad dragooned me into functioning as a deputy parent, Mom roped me in as a kind of surrogate husband. I’ve heard this dynamic described as emotional incest. That began when I was about eleven and continued until I was fifteen.

In June 1971 I went off to a Boy Scout camp, and I recall that on the day I left Mom was manic, though not yet hospitalized. She pranced about the house, hugging a Bible and declaring in a sing song voice, "I'm going to read the Good Book! I'm going to read the Good Book!" On her face was a ghastly, unworldly grin.

Two months later she attempted suicide for the first time -- certainly the first time as far as I know. The rescue squad came and took her to the hospital, where she had her stomach pumped. She came home the next day. I remember standing in the carport, practicing semaphore for some Boy Scout merit badge, when Dad brought her home. She walked up the driveway and into the house. We kids did not know how to react, so we were pretty low-key. Evidently that distressed her, because Dad came out and asked us to go in and tell Mom how much we loved her. Actually it’s not quite correct to say we did not know how to react -- we’d been mirroring how Dad was handling it, and he was pretty much stone-faced. Had he been more demonstrative, we would have been.

It was after this episode that Mom got a new psychiatrist, Dr. Novak, who was one of the few psychiatrists in the country authorized to prescribe lithium, a then-new treatment for manic depression. (New, that is, in the United States. The efficacy of lithium had been recognized in the 1940s and in Europe by the 1960s it was a common treatment.) Mom improved a lot once she started taking it. She became a substitute teacher and was so good at it that when a regular teacher fell ill and would be out the rest of the school year, Mom was asked to take over the class. Within a couple of weeks, however, she had a third manic episode. I don’t know whether the lithium was ineffective, or whether she’d gone off her medication, or what exactly occurred to trigger the episode beyond the fact that she was having fun teaching and feeling energized and productive. But she had to be hospitalized and her days as a teacher ended, this time for good.

Part 1 - Part 2 (coming)

A Bipolar Blogroll

You can't have a blog without a blogroll, so I've created one here. With the exception of Blog Them Out of the Stone Age (my military history blog), all of them deal primarily with bipolar disorder. I've encountered one or two of them before. The rest are drawn mainly, though not exclusively, from PsychCentral's list of the Top Ten Bipolar Blogs of 2008.

The selection is tentative. Whether they'll remain on my blogroll is going to be a function of time and utility. Time in the sense that so far I've scarcely done more than skim a few entries; utility in the sense that some of them will probably prove more useful for my purposes than others. Then too of course there are the considerations that apply to pretty much any blog. Is it well written? Does it have a voice? Does it stay generally on topic? Is it updated on a regular basis?

From what I've seen thus far, blogs about bipolar disorder tend to have three characteristics.

First, they are heavily didactic in tone. They seek to educate others about the illness and/or to help those with the disorder manage it better. Sometimes they critique the mental health establishment, particularly the prescription of psychotropic medications.

Second, many take a rather catastrophic view of the illness. For most of them it seems to be a huge struggle that dominates their lives, as in some cases it indisputably does . All in all, the effect is to create the impression that bipolar disorder is not something they have, but a major component of who they are.

Third, and perhaps as a corollary of the second characteristic, the authors commonly refer to themselves and others with the disorder as being bipolar or, in at least one case, terming persons like myself "bipolars," as if we were a unique subset of humanity.

People are entitled to view the disorder in any way that seems helpful to them. I mention these characteristics not to judge, but rather to say that while I find most of them interesting, I identify with few of them. That's because I conceptualize the illness as external to me and simply something to be managed.

Nonetheless, they do provide a window into the disorder, and probably as time goes by I'll discover other blogs more relevant to my own situation and perspective.

A Mood Watch Retrospective

On another blog, since discontinued, I had a category entitled "Mood Watch." In those posts I made an effort to track my moods, something that persons with bipolar disorder are often encouraged to do. I've decided to incorporate them here, using the dates of the original posts, so that they seem to antedate the beginnings of this blog. The first such post is here.

It took a while to transfer these posts, partly because there were rather a lot of them, and partly because I was careful to date stamp them precisely -- not just with the month, day, and year but also with the exact time of publication. The exact time can be useful because it usually provides a clue as to how well I was sleeping, and good sleep hygiene (which is to say going to bed and waking up at about the same time, getting sufficient sleep, etc.) is an important element in managing the disorder.

As I went through these old posts, two things stood out. The first was how few there were, considering that I had composed them over a period of about two years. It just isn't a lot of fun to keep track of one's moods. The second was how many encouraging comments the posts received. Without them I would probably have ceased the practice long before I did.

As to whether I'll resume these posts, I can't yet say. I probably will describe what the disorder feels like subjectively, particularly the depressions, which for me are much more frequent than the hypomanic episodes. Indeed, I haven't had a significant hypomanic episodes in years.

In fact, it's hard to know exactly what shape this blog will take. Like any writing project it eats time and it's not exactly a comfortable sensation to put so much of myself out there for people to read. Still, I regard it as a useful service; and if you find it worthwhile, I'd sure appreciate your leaving comments. They're likely to be one of the more important things that keeps me going.

Twitter in Direct Support

Originally published in Blog Them Out of the Stone Age on July 9, 2009

If you scroll down on the sidebar of this blog, you'll find a section labeled "Twitter Updates," thanks to a widget I installed a few days ago. The question is, how does this relate to military history?

As long time readers of the blog are aware, I have bipolar disorder. The subject is covered in the category "Facing the Demon," along with battle stress injury -- not because I think the two are identical: one is an illness, the other an injury -- but because both require management and both carry a perceived stigma that requires a degree of courage to address. In my own case, I was diagnosed with bipolar disorder when I was twenty-six and have probably had it since the winter of my seventeenth year. It took a long time to come to grips with it. Until I was thirty-seven I didn't fully accept the reality of the disorder -- that it was something I had and would always have and that it needed to be managed precisely as one would manage any other chronic illness, such as diabetes, which in some respects it resembles. Both are abnormalities in one's biochemistry.

In the years since, I've gradually become conscious of the fact that in dealing with the illness I instinctively draw upon a number of concepts derived from a lifetime steeped in military history, strategic studies, and my own modest military experience. The most basic insight derives from Clausewitz: "In war, the best strategy is always to be very strong." This translates metaphorically into identifying as using as many tools to combat the illness as I can. Many of them are predicated on a crucial decision I made as soon as I received the diagnosis; namely that I would acknowledge it openly. As I've written elsewhere:

People often think that because I’m so up front about having bipolar disorder, that being candid about the illness must be an easy thing for me to do. In fact, it scares me. I’m up front about it only because I’m convinced that candor is better than the alternative. Being open with my colleagues, for example, populates the department with observers who have a decent chance of identifying unusual behavior as an artifact of the illness rather than erroneously attributing it to something else: simple high spirits instead of hypomania, for example. It enables me to ask for help when necessary without having to explain the illness from scratch. And it gives me a chance to combat, in a small way, the stigma that still attaches to mental illness. If a professor protected by tenure cannot summon the modest courage required for such an act, I do not know who can.

So where does Twitter come in?

I've decided to use this social utility as a way to discuss the illness, not abstractly, but as it affects my day to day life. (The updates, by the way, appear not just on the blog but are immediately cross-posted as a status update on Facebook.) Since I find the prospect of doing so a bit daunting -- it is one thing to state publicly that I have the disorder, quite another to state on a given day that I'm depressed -- I've begun with something reasonably safe: namely to keep public track of my workouts at the gym (and other forms of exercise). This has more to do with bipolar disorder than one might suppose. Coping with bipolar disorder involves more than taking medication. There are things one can actively do to manage the illness, among them getting enough sleep and getting enough exercise, which releases beneficial endorphins.

So announcing each trip to the gym is not based on vanity or the assumption that people are fascinated with the mundane details of my life. It's the early stage of what I expect will be a larger experiment in publicly sharing the experience of managing bipolar disorder, partly as a means to expand my network of support, but primarily to model in practical terms how one goes about it, and to treat the illness as one would any other: not something of which to be embarrassed or ashamed but a simple fact of existence.

What If Churchill Hadn't Tamed His "Black Dog"?

Originally published in Blog Them Out of the Stone Age on May 22, 2009



Reprinted with permission of World War II Magazine

In March 2006 a statue of Winston Churchill went on display in Norwich, England. It might have attracted little attention but for one disquieting detail: it showed the prime minister in a straitjacket. The statue was part of a campaign by Rethink, the mental health advocacy group that commissioned it.

“We are trying to break down the stigma of mental illness,” explained a spokesman. “Churchill documented his depression and referred to it as his ‘black dog.’ Nowadays it would be described as bipolar disorder or manic depression. We all know that Churchill was a great leader and this statue is an illustration of what people with mental illness can achieve” —- that is, without the cruel caricatures that too often burden those with such illnesses.

Indeed, the controversy in the wake of the statue’s unveiling underscored the point Rethink was trying to make. Many Britons cried foul. “It’s not only insulting, it’s pathetic,” growled Nicholas Soames, grandson of the former prime minister. The outcry forced Rethink to remove the statue after only a few days. The organization had miscalculated the public’s receptivity to such a portrayal of a national icon. But had it been mistaken about Churchill’s illness itself?

Full article (PDF)

Pharmaceuticals in Direct Support

Originally published in Blog Them Out of the Stone Age on June 9, 2008

The current Time magazine features a cover story entitled "A Medicated Army," discussing the practice of prescribing antidepressants and antianxiety meds to soldiers in combat environments:

For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

As many readers know, I have bipolar disorder, and consequently have a long acquaintance with many of the meds being prescribed. At the moment, for instance, I take Lamictal on a daily basis and clonazepam (the generic equivalent of klonopin) as needed. The former operates as an antidepressant. It has mood stabilizing properties that make it a reasonably good prophylactic against mania -- in fact I've had no trouble with incipient "highs" since I began taking Lamictal about two years ago. The latter is a mood stabilizer and anti-anxiety med. The biochemical manifestations of bipolar disorder are more complex than most people suppose. I have had days when I felt neither up nor down, but had such an insistent sense of generalized anxiety that I had to cancel class because I felt too light-headed to responsibly drive down to campus. Once I grasped its beneficial properties, clonazepam has done a lot to alleviate that problem. I also take the generic form of Ambien on a fairly regular basis in order to make sure I get a good night's rest. Regular sleep -- what's known as "good sleep hygiene" -- is a bedrock element in managing the illness.

The situation of a college professor in the midwest is obviously dissimilar from that of a combat soldier in Iraq or Afghanistan, but I think my experience can contribute a degree of insight. To begin with, I think it's important to regard the meds as simply a tool to assist with the overall task of maintaining good health. There's a tendency for those who take them to regard them as a sort of query against their character: that if they were somehow stronger they wouldn't need to take the meds. That leads to problems. First, it reduces self-confidence and self-esteem. Second, it often creates a state of partial denial in which a person may take the med, but does not acquaint himself closely with the medication's properties. He may not follow the guidelines for taking the med responsibly and when he feels better may quit taking the meds entirely. (Medication noncompliance is the single biggest problem among those with bipolar disorder.)

Third, there can be a tendency to regard the meds as shouldering the whole burden of managing the problem, whereas I have found it helpful to take an active role in managing the disorder rather than just passively taking the pills. I monitor myself for symptoms, even subtle ones that no one around me would recognize. I try to exercise on a regular basis. I make use of as many other tools as I can gather to help with the job: a psychiatrist, a therapist, and also the support of friends. There's too much tendency to let fears of the stigma prevent a person from letting others know about one's situation. But I've found that for every jerk there are many people who welcome the opportunity to be of assistance.

Finally, I have made a personal commitment to be public about having bipolar disorder. In each course I teach, I find a topic that lends itself to disclosure that I have the illness (in the U.S. history survey, for instance, the work of 19th century reformer Dorothea Dix provides a good opportunity). In a class of 200 students, statistically two students have been or will be diagnosed with bipolar disorder. I have never yet disclosed the illness and not received subsequent contact from a student who has the same diagnosis. They express appreciation for my candor and particularly a sense of relief in realizing that they are not alone, and that someone they regard as highly functional can have the disorder and lead a reasonably normal life. I often wind up meeting with them to discuss the illness and how best to manage it. Students usually have a lot of concerns: What will their life be like? what degree of stigma will they face? Frequently they do not yet have in place a good support system for managing the disorder. I recently spoke with a student who has no psychiatrist and therapist; her prescriptions are written by a general practitioner. I've been able to assist with referrals to good psychiatrists and therapists within her health care network.

How does this relate to military personnel who take psychotropic meds? First, I wonder how many officers and NCOs self-disclose that they are taking the same meds. If they keep this info away from their soldiers, they send a double message: overtly it's OK for you to take these meds, but tacitly it's really not because I wouldn't be caught dead letting you know that I take them myself. It would require real moral courage, but an officer willing to talk matter of factly about taking these meds, and at the same time functioning effectively as an officer, would serve as a powerful role model. (I find that's the role I often play with my students.) Such an officer's example could not only reassure the soldiers who take the meds, but would also help shift the military culture toward one in which other soldiers would find it easier to trust and support their comrades in arms.

Second, I think it's important to de-mystify these drugs as much as possible, so that the fact of taking them does not, in its own way, add to the issues that soldiers must face. To repeat, taking a med to assist with a problem is not a confession of weakness or bad character. On the contrary, it takes strength and maturity to face up to a problem squarely and do what it takes to accomplish the mission -- whether that mission is to maintain one's health as a civilian or one's effectiveness as a soldier.

Third (and as a corollary), I have found it useful to apply, metaphorically, the warrior ethos to the task of managing the illness. I conceptualize bipolar disorder as an enemy that will never cease in its efforts to destroy me -- either outright or by destroying my quality of life -- and that consequently I have to work conscientiously and intelligently to keep it in check. I've found that my military training and my familiarity with strategic studies have come into play, in various, sometimes unexpected ways, to help me do this.

It would be wrong to create a sunny picture. Even in my safe suburban life, the task of managing bipolar disorder requires a lot of vigilance and is not without its setbacks. For obvious reasons the problem is compounded for those in combat zones, and the last thing I would ever want to suggest is some sort of situational equivalence. At the end of the day, shorter tours of duty and regular rotation into safe areas (such as they are) is a better solution to the problem. But until then, if the Army is going to pursue what I regard as a sensible 21st century policy -- to treat issues of depression, stress and anxiety as problems to be solved rather than defects to be scorned -- then it needs to shift the military culture to conform with the policy. I hope these insights from my own situation, however modest, may be of some help.

Run to Failure - Pt 2

Originally published in Blog Them Out of the Stone Age on December 10, 2005

"Run to failure" is a term I learned many years ago in a war and technology course. It's used by engineers when designing something that has lots of moving parts. You design, say, an aircraft engine. You build a prototype and let it run until it fails. Then you root around the prototype until you locate the specific part that failed. You figure out why it failed, design and manufacture an improved version of the part, install it and then run the engine until the next failure. You repeat the process until you have an engine that meets or exceeds the required specifications. That's "run to failure."

Over the last two decades, I've used "run to failure" numerous times to improve the system I've evolved to protect myself from the sort of acute manic episode that evidently killed Rigoberto Alpizar. An analogous concept would be the "lesson learned" analysis commonly employed by the armed forces: you create a doctrine, then revise it in light of practical experience -- war games or actual battle.

I described the core of the system in a previous post. Briefly, it's to marshal as many resources to combat the illness as I can: medications, therapy, good sleep hygiene, regular exercise, and so on. Equally important is to have in place a strong network of friends and colleagues who know that I have the disorder and have been briefed about its symptoms. This network has proven itself so thoroughly that the question of whether to be private or "out of the closet" about the disorder is a settled issue with me. It is better to have as many people know about the condition as possible.

True, there are downsides. I've no doubt that my openness makes some people uncomfortable and that they rationalize their discomfort by telling themselves -- and perhaps others -- that it is "inappropriate" or that I have "boundary issues." It is even possible that I could never get a job in another university. Tough. One of the things I learned in the Army is that you do what is necessary to accomplish the mission. My first mission is survival. Other considerations take a back seat.

Run to Failure - Pt 1

Originally published in Blog Them Out of the Stone Age on December 9, 2005

Left: Anne Buechner and her husband, Rigoberto Alpizar

Two days ago the couple in the photo were returning to Florida after a brief missionary trip to South America. The international leg of the flight was behind them. They had cleared customs, boarded a second aircraft, and faced only the final, brief trip from Miami International Airport to Orlando. Suddenly the man, 44-year old Rigoberto Alpizar, began acting in a way that attracted the attention of the flight crew and an air marshal on board the craft. The marshal became convinced that Alpizar had a bomb and, when he bolted from the plane rather than heed the marshal's command to halt and lie down, the marshal shot him dead.

The story has been international news for a couple of days now. The dominant theme has been that it was a "good shoot" -- that is, the air marshal behaved properly in the circumstances -- and serves as evidence that security measures entrenched since 9/11 are working as they should. But it soon transpired that Alpizar was not, in fact, carrying a bomb. His behavior owed not to lethal intent but rather to his medical condition: He suffered from bipolar disorder and, in medical terms, had "decompensated," apparently because he was off his medication.

Valuable Partners

Originally published in Blog Them Out of the Stone Age on September 8, 2005

The Ohio State University is still on the quarter system, which means, among other things, that Autumn classes do not begin until late September. So around here the students are just now beginning to return. But four of my five graduate advisees are in town now, so this morning we're going to meet as a group.

Within the history department I have a foot in two fields: American History to 1877 and, of course, Military History. My career has largely been a matter of shifting my weight back and forth between them, sometimes laying stress on the one, sometimes on the other. That is not uncommon. Indeed, I think it is pretty much the norm for professors in thematic fields. Two of my advisees are early Americanists; three are military historians. In other years the balance has actually been the other way. And indeed, two of the three dissertations that I have signed as principal adviser were in early American history.

But the dividing line is artificial. As Clausewitz says, "War has its own grammar but not its own logic." The logic is driven by the policy of governments and the passions of people, among many other things. So a good military historian has to be a broadly grounded historian. And since the United States is a country that was literally made by war, a good American historian must know some military history.

Still, the brute fact of the job market is that positions in American history far, far, far exceed positions in military history. Which is why I insist that my military history advisees, when it comes to their PhD general exams, should be as strong in their second field--which is usually early American history--as their first. I'm not trying to be a jerk about it; I'm trying to maximize their chances on the job market.

I will give an example. The day I gave my job talk here at Ohio State, the first question I received had nothing whatsoever to do with the subject of my presentation. Instead I was asked what I thought of the debate between Eugene Genovese and James Oakes as to whether the antebellum South was a pre-capitalist society or whether it was as capitalist as the North, albeit in different ways. The whole point of the question was to show me up, to demonstrate that I knew nothing beyond pure military history, whatever that is. Guns and battles, I guess.

You might think I resented the question, but that's like thinking a a baseball player at bat resents the pitcher on the mound. It gave me precisely the opportunity I needed to destroy the stereotype about "narrow military historians." I launched into a discussion of the main works of Genovese and Oakes, explained the reasons for their disagreements, and concluded that it was too early to tell which one was right. My questioner later told me he wasn't really satisfied with my answer and I'm sure it wasn't as good a response as he could have given. But so what? Most of the people in the room were non-Americanists who didn't know a damn thing about the Genovese/Oakes debate. To them it sure sounded as if I knew what I was talking about.

Contrast that with the impression I would have made if I had said, "I don't know about that." Or worse, tried to stumble through an answer on the basis of dim memories of a debate on which my grasp had been tenuous to begin with. I would not have recovered. Worse--because to tell you the truth I didn't really believe this department would actually hire one of its own no matter what I did--I would have let down the military history program. I always thought of my real objective as making the program look as good as possible in the eyes of the department. If I got the job, that was gravy.

And pretty good gravy it has turned out to be.

So my military history advisees need to see my early American advisees as valuable partners. But what do the American advisees get out of it? Well, they almost invariably choose me because military history informs their research or because they want to be historians of the Civil War era, and any historian of that era ought to know a good deal about military history. They need my military history advisees as pards, too.

Beyond these remarks I don't actually know what I'll tell them when we meet. In a way my main job is just to bring the coffee and croissants and let them renew acquaintances or get to know each other if they haven't met already. I would tell them about the fact that I have bipolar disorder if they didn't all know it already. It is one of the first things I tell potential advisees. I want them to see that I am not ashamed about it and I think of it, and manage it, as an illness. I explain the symptoms and tell them what to do and/or who to contact if they become concerned about me. I think it is their business to know, because they are placing a good deal of their future prospects in my hands. And if they can't handle the knowledge it is better for both parties if this is recognized at the outset.

But thus far my graduate students have been comfortable with my frankness on this subject and even somewhat reassured, because it implies that they can come to me with their own concerns when necessary. It is, to be sure, a matter that has to be handled in a sure-footed manner, because it is important to maintain a professional demeanor and to preserve, in a healthy way, the distinction between my status as a faculty member and theirs as a student. But they are also adults--actually remarkably accomplished adults--and they deserve to be treated as such.

SITREP

Originally published in Blog Them Out of the Stone Age on July 12, 2005

It's been nearly a month since my last blog post. That's partly because I have adhered to my rule of making this blog an aid to productive scholarship, not a diversion from it. It's partly because the next posts that follow logically from Crash and, especially, Shadow Warriors, Pt 8, are ones that I have been reluctant to write, much less publish -- though I guess in the next few days I will have to embark on them. But mostly it has been due to the fact that I've spent much of the period in a state of clinical depression.

Facing the Demon

Originally published in Blog Them Out of the Stone Age on June 5, 2005

But besides the achievement of this functional and corporate aim, the rote-learning and repetitive form and the categorical, reductive quality of officer-training has an important and intended -- if subordinate -- psychological effect. Anti-militarists would call it de-personalizing and even de-humanizing. But given -- even if they would not give -- that battles are going to happen, it is powerfully beneficial. For by teaching the young officer to organize his intake of sensations, to reduce the events of combat to as few and as easily recognizable a set of elements as possible, to categorize under manageable headings the noise, blast, passage of missiles and confusion of human movement which will assail him on the battlefield, so that they can be described -- to his men, to his superiors, to himself -- as "incoming fire, "outgoing fire," "airstrike," "company-strength attack," one is helping him to avert the onset of fear or, worse, of panic and to perceive a face of battle which, if not familiar, need not, in the event, prove wholly petrifying.

-- John Keegan, The Face of Battle

Diagnostic Criteria for Major Depressive Episode

For a diagnosis of a major depressive episode, these are the signs and symptoms doctors are looking for:

The Scare - Pt 2

Originally published in Blog Them Out of the Stone Age on April 28, 2005

Deception is a fundamental aspect of war. The enemy systematically tries to mislead you as to his real intentions and capabilities, which leads to uncertainty and therefore often anxiety. The most formidable adversaries are usually masters of this. I once wrote on this subject using as my example Confederate cavalry general Nathan Bedford Forrest:

"Warfare, despite its various refinements, touches basic human emotions. The most fundamental of these is fear. It is not difficult to imagine that Forrest's [prewar] days on the Mississippi frontier had educated him in the coarse art of instilling fear. The key was to rattle an opponent and keep him rattled. Forrest had an expression for it: "Keep up the scare." When he advanced toward [the Federal garrison at] Jackson [Tennessee] with kettle drums beating to simulate infantry, and when he suddenly swung on his pursuers at Parkers Crossroads, Forrest was doing his best to generate fear. There was nothing really novel in this approach: the violence of war can have no other purpose than the creation of fear through the threat of wounds and death. But Forrest was unusually clear-eyed about the value of inflicting fear. He did it instinctively and he did it well."

The experience of depression is often much like this. Joy simply drains out of life, replaced by listlessness, anxiety, even outright dread. The actual cause of the depression may be biochemical but the mind, spurred by the illness, searches for a circumstantial explanation and always finds it. In broad outline the illness "keeps up the scare" by playing on universal fears: that one is a failure, that one is unloved and unlovable, that life itself is meaningless. But the details are insidiously specific to each individual because the illness, in effect, knows what scares you most.

Part 1 - Part 2

The Scare - Pt 1

Originally published in Blog Them Out of the Stone Age on April 28, 2005



Part 1 - Part 2

My Favorite Clausewitz Quote

Originally published in Blog Them Out of the Stone Age on April 27, 2005

In a previous post, I alluded to having a mood disorder called bipolar disorder, once known as manic-depression.

Note the formulation: "I have bipolar disorder," not "I am bipolar." Though I'll need to sketch some background first, the thrust of this post turns on that distinction, and on the utility of combat as metaphor in making the distinction helpful.

Bipolar disorder is, strictly speaking, a malfunction of one's biochemistry whereby the mind is tricked into varying degrees of euphoria or despair with scant regard to the actual circumstances of one's life. I have often been discouraged by health care professionals from regarding it as a true mental illness at all. I tend, however, to regard such admonitions as well-intentioned efforts to spare me from the shame of mental illness. But rather than duck it, I'd rather work to dispense with the shame itself. If a tenured professor cannot summon the modest courage required to do so, then I don't know who could reasonably be asked.

Moments of Decision - Pt 2

Originally published in Blog Them Out of the Stone Age on April 14, 2005

I have Bipolar Disorder : what used to be called "manic depression."

I was diagnosed with the disorder in September 1986, shortly before my twenty-seventh birthday. I have since concluded that the actual onset of the disorder most likely occurred almost a decade before that, in the winter of my seventeenth year.

Friends, colleagues and, indeed, almost anyone who has ever met me face-to-face will be unsurprised by this information, since from the outset I made the decision never to act as if I were embarrassed or ashamed to have the disorder. Close friends also know that I have long been looking for the right moment to "go public" with this information. I myself have known, since the day I began keeping a blog, that one day I would be composing this post. On the whole, I am surprised I wound up waiting as long as I have.

The principal reason for waiting is that while I figured I would go public with the news in this medium--and by go public I mean to share this information with people whom I cannot look in the eye as I do so and gauge their reaction--I wanted the focus of the blog to remain unchanged. My principal concern continues to be to assess the prospects of military history as an academic field. It's simply that I wish now to introduce the "canon of military history" as I have experienced it personally: a very rich set of metaphors by which to manage and survive the inevitable struggles of life. True, I could use other examples, but to do so would feel so much to me as if I were dodging the most obvious example that I would be violating my first rule concerning the disclosure of my having bipolar disorder: when, within a given context, the most direct response involves acknowledging the disorder, always acknowledge it.

Acknowledging it, however, turns out not to be the same thing as accepting it. The rest of this entry was composed in November 1997, a day or two after my return from a weekend staff ride on the Antietam battlefield with officers and cadets from West Point. (If you read Starship Troopers, Civic Virtue, and the American Civil War you will be reading an essay that I dashed off in twenty minutes, gave improvisationally to a group of thirty plebes who cheered me at the end, and then revised into present form all while hypomanic . As you'll see, initially I failed to make the connection between my mood and the manic episode in 1986 which led to my hospitalization and diagnosis. But look at my choice of wording and examples when I finally, reluctantly, did make the connection. You'll begin to get an inkling of the ways in which I routinely use combat as metaphor.

Moments of Decision - Pt 1

Originally published in Blog Them Out of the Stone Age on April 13, 2005






Bullfight critics row on row
Crowd the enormous plaza de toros
But only one is there who knows
And he is the one fights the bull.

-- Translation by Robert Graves of a poem by Spanish matador Domingo Ortega

(Photographs by Lester Silva)

Part 1 - Part 2

What This Blog Is About

I have bipolar disorder -- specifically Bipolar I. It was diagnosed shortly before I turned 27. However, the most likely time of onset was the winter of my 17th year. I've always made a point of being up front about having the disorder. For instance, I'm a college professor, and when appropriate I've disclosed it to my students. I've talked about the disorder with undergraduates in a psychology course and have written about it from time to time, most notably in a column in Inside Higher Ed entitled "An Inappropriate Illness," which appeared in September 2006. I've also discussed it on my principal blog, Blog Them Out of the Stone Age (here abbreviated BTOOTSA), which is devoted to academic military history and national security affairs but which occasionally addresses bipolar disorder (as well as battle stress injury), under the category "Facing the Demon." Which of course inspired the title of this blog. For the sake of convenience I'll republish the relevant posts here. If nothing else, that will save me a lot of repetition.

Over time I've discovered that it helps others as well as myself to be candid about having bipolar disorder. If in a large lecture course I have over two hundred students, then statistically two of them have been or will be diagnosed with the illness. Indeed, in the past whenever I've disclosed that I have the disorder invariably one or two students approached me afterward to talk about it, because they too had the illness. Usually they felt rather isolated. They found it difficult to discuss the illness with others or they had trouble feeling understood. They also wondered about its implications for their future. Would they be able to lead a normal life? And usually they had questions about how best to manage the illness. The same thing has happened with adults as well.

A few days ago I posted the following on BTOOTSA:

If you scroll down far enough on the sidebar of this blog, you'll find a section labeled "Twitter Updates," thanks to a widget I installed a few days ago. The question is, how does this relate to military history?

As long time readers of the blog are aware, I have bipolar disorder. The subject is covered in the category "Facing the Demon," along with battle stress injury -- not because I think the two are identical: one is an illness, the other an injury -- but because both require management and both carry a perceived stigma that requires a degree of courage to address. In my own case, I was diagnosed with bipolar disorder when I was twenty-six and have probably had it since the winter of my seventeenth year. It took a long time to come to grips with it. Until I was thirty-seven I didn't fully accept the reality of the disorder -- that it was something I had and would always have and that it needed to be managed precisely as one would manage any other chronic illness, such a diabetes, which in some respects it resembles. Both are abnormalities in one's biochemistry.

In the years since, I've gradually become conscious of the fact that in dealing with the illness I instinctively draw upon a number of concepts derived from a lifetime steeped in military history, strategic studies, and my own modest military experience. The most basic insight derives from Clausewitz: "In war, the best strategy is always to be very strong." This translates metaphorically into identifying as using as many tools to combat the illness as I can. Many of them are predicated on a crucial decision I made as soon as I received the diagnosis; namely that I would acknowledge it openly. As I've written elsewhere:

People often think that because I’m so up front about having bipolar disorder, that being candid about the illness must be an easy thing for me to do. In fact, it scares me. I’m up front about it only because I’m convinced that candor is better than the alternative. Being open with my colleagues, for example, populates the department with observers who have a decent chance of identifying unusual behavior as an artifact of the illness rather than erroneously attributing it to something else: simple high spirits instead of hypomania, for example. It enables me to ask for help when necessary without having to explain the illness from scratch. And it gives me a chance to combat, in a small way, the stigma that still attaches to mental illness. If a professor protected by tenure cannot summon the modest courage required for such an act, I do not know who can.

So where does Twitter come in?

I've decided to use this social utility as a way to discuss the illness, not abstractly, but as it affects my day to day life. (The updates, by the way, appear not just on the blog but are immediately cross-posted as a status update on Facebook.) Since I find the prospect of doing so a bit daunting -- it is one thing to state publicly that I have the disorder, quite another to state on a given day that I'm depressed -- I've begun with something reasonably safe: namely to keep public track of my workouts at the gym (and other forms of exercise). This has more to do with bipolar disorder than one might suppose. Coping with bipolar disorder involves more than taking medication. There are things one can actively do to manage the illness, among them getting enough sleep and getting enough exercise, which releases beneficial endorphins.

So announcing each trip to the gym is not based on vanity or the assumption that people are fascinated with the mundane details of my life. It's the early stage of what I expect will be a larger experiment in publicly sharing the experience of managing bipolar disorder, partly as a means to expand my network of support, but primarily to model in practical terms how one goes about it, and to treat the illness as one would any other: not something of which to be embarrassed or ashamed but a simple fact of existence.

It would distract from the main purpose of BTOOTSA to constantly inject posts about bipolar disorder, but without supplying context the near-daily announcement that I'm going to, or have returned from, the gym would seem banal. Consequently I've created this blog in order to supply the context.