Janet Coburn

@janet-coburn | contributor
I am a freelance writer and editor who has bipolar disorder, type 2, and anxiety disorder. I blog weekly at bipolarme.blog. I have two published books, Bipolar Me and Bipolar Us, which are available on Amazon, Barnes & Noble, and other outlets.
Janet Coburn

What's the Difference and Similarities Between Anxiety and Mania?

“Ha,” you say. That’s an easy one. I know the answer to that. It’s like the difference between walking on pins and needles and walking on eggshells. For me, anxiety is the pins and needles, while mania produces the eggshells. Pins and needles hurt more, but eggshells are easier to break. Anxiety causes me more pain, but mania has me treading carefully on a fragile edge. I know more about anxiety than mania. My diagnosis is actually bipolar disorder type 2 with an anxiety disorder. As such, I never really experience true mania. Hypomania is about as far as I get. And believe me, that’s enough. First, let’s start by admitting that anxiety and mania have a lot in common. At least, they do in my life. Both of them make me frantic. Both of them make me obsessed with money. Both disrupt my eating habits. And both of them make me very, very twitchy. 1. Frantic. Both anxiety and hypomania make me feel frantic, like there is something I need to be doing to alleviate them. I know this isn’t true, that they are out of my control, but it feels that way. I get all revved up inside, a nagging, prickly feeling that jangles my nerves and irritates my brain. I try desperately to think what it might be that would calm the feeling, but there is nothing this side of an anti- anxiety pill, which might or might not help. 2. Obsessed with money. With anxiety, I obsess about the bills and how I am going to pay them. With mania, I obsess about what money I do have and how I can best spend it. Since this is, after all, hypomania , I tend not to go on wild spending sprees, but I have been known to buy myself or my husband presents, telling myself the costs are comparatively reasonable and that at least I have limited myself to a non-extravagant amount. (Which may be the anxiety and the hypomania arguing with each other.) With anxiety, I try to anticipate all possible bills and juggle their amounts, due dates and relative necessity (like power cut off or trash removal cut off). I take on extra work, not because I think I have the wherewithal to do it, but because I want the extra money, no matter what it costs me in terms of physical and emotional energy. 3. Eating habits. Both anxiety and hypomania make me eat more than usual. With anxiety, no doubt I am trying to fill an existential hole or find something to distract me from my worries. With hypomania, I crave the relatively safe sensations of rum raisin ice cream, cinnamon danish, or salted, buttery popcorn. 4. Twitchy. Both anxiety and hypomania can cause the shakes, tremors in my hands and arms and legs. Alas, not for me; I don’t get the euphoria of true mania, but the inherent sensation that I’m doing something wrong at some level. I can’t even enjoy hypomania without guilt. There are differences, however. Anxiety leaves me immobilized, in a way that hypomania just doesn’t. You’d think with all that nervous energy vibrating around my body and brain, I would hyper myself into a frenzy. Instead, all the jitters cancel each other out, leaving me with no place I can go to escape. My fears leave me frozen. The money worries leave me unable to decide what bill to pay first. I can’t decide whether it’s better to stay awake and try to read (if I have enough ability to concentrate), or take that anti- anxiety pill and try to rest, if not sleep. Mania can make me productive, in a way that anxiety can’t. When I’m hypomanic, I can write, or at least put words on the screen. (Whether they’re any good or not is anybody’s guess.) But at least I have the illusion of motion, the impetus to create. That extra energy seems more focused, at least in comparison with anxiety. When I hit a hypomanic jag, I sometimes try to get ahead on my blogs, or at least jot down titles and ideas that I hope I can decipher and develop later. Neither state of mind is preferable. Anxiety is the more painful and hypomania the more fragile. Anxiety is more familiar to me and hypomania more rare and even exciting. But I can’t choose. I can’t say I like hypomania more than anxiety, although it does seem to have more benefits. But I know it can be destructive and futile, promising things it can’t fulfill. Given the choice, I’d rather not walk on pins and needles or on eggshells. Level ground is fine with me.

Janet Coburn

What Life With Bipolar II Disorder Is Like

I have bipolar II disorder. This is my story. First, some background. Bipolar disorder used to be called manic-depressive illness, and many people still know and refer to it that way. The term “bipolar” reflects the concept that there are two extremes to the continuum of mood disorders, and some people swing dramatically from one to the other. According to this definition, clinical depression by itself is “unipolar,” occupying only one end of the spectrum. Depression is to sadness as a broken leg is to a splinter. Depression sucks the life from a person, mutes all emotions except misery, denies any possibility of joy or even contentment and makes life seem meaningless or impossible. This is hell. Mania is to ordinary happiness as diving off a cliff is to diving off a diving board. Mania brings exhilaration, ambition, confidence, abandon and invincibility, with no brakes. It is hell on wheels. Oscillating between the two extremes, that’s bipolar disorder, type 1. It is a serious illness. Left untreated, it can cause destruction of families, careers and more. It can lead to psychosis or suicide. The treatments for it are no picnic either. A severe case of bipolar disorder often requires hospitalization. If the symptoms can be controlled with medication, then the patients must have frequent blood tests to assure that the drug is present in the right quantity. When I was (incorrectly) diagnosed with unipolar depression, I used to wish that I were bipolar, on the theory that at least then I could accomplish something. Boy, was I wrong about that. Plans made in mania never come to fruition. They are started, rethought, abandoned, exchanged for something grander and ultimately fizzle out when the mania wears off. My diagnosis actually made some sense at the time, as I never experienced anything like the manic highs. All I got were depressive lows. This leads us at last to bipolar II disorder. The mood swings are not as extreme, the lows less debilitating and the highs less overwhelming. The person with bipolar II stays closer to a baseline of normal mood, but still experiences swings back and forth. Technically, the mini-lows are called dysthymia and the mini-highs are called hypomania. In my case, the lows were just as low as in unipolar depression, but I never got the mini-jags of buoyancy that accompany hypomania. Instead, these feelings, came out sideways, as anxiety. My brain was still racing with little control, but in a different direction. Instead of elation and purpose, I was beset by in worries, fears and catastrophizing. One of the difficulties with treating bipolar disorder (of either type) is trying to find a medication or a combination of medications that will level out the person’s moods. Usually this requires more than one drug, and finding the right mix or cocktail of chemicals usually requires more than one drug. It takes a great deal of trial and error. In the meantime, the mood swings continue. At this point, my bipolar II is fairly well-controlled on medication. I still have spells of depression. Now, they last at most a week and sometimes just a day or two. Untreated, they could last months or years. I still have anxiety too. However, I have the medication I take for that so I don’t feel like I’m about to jump out of my own skin. Most of the time, I’m fairly high-functioning. I can write, work and earn a living. I have a great marriage and a number of friends, including some who are closer than family to me. I have never been hospitalized, nor have I had electroshock (though that was a near thing). Before I got my proper diagnosis and treatment, I would have not believed this to be possible. My goal in life was simply to stay out of a psychiatric hospital as long as I could or at least until I qualified for Social Security Disability. I’m sharing these experiences with you today because I believe mental disorders should not be hidden or viewed with shame and horror as they have been in the past and sometimes the present. It’s undeniable that there is a stigma associated with having mental illness. Going public with it entails a risk. I’ve seen the fixed “smile and back away slowly” reaction. I’ve seen sudden turnarounds in my work performance evaluations, but I’ve also seen the, “Me too!” response. There is strength in numbers. As more of us who live with psychiatric conditions talk about it and share our stories, the more we build understanding. Perhaps, we also encourage those who are “roller-coastering” to seek treatment. So that’s the nuts and bolts of it: Bipolar II disorder is a mental illness. I have it and live with it every day. I do not go around threatening the safety of other people or my own. I take medication for it. I know I will likely have to for the rest of my life, and I’m OK with that. I hope that eventually the rest of the world will be, too. If you or someone you know needs help, visit our suicide prevention resources page. If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741. We want to hear your story. Become a Mighty contributor here. Image via Thinkstock.

Janet Coburn

My Anxiety About Driving on the Left When Vacationing in Ireland

Over the last couple of months, I’ve written about the anxiety I’ve been having regarding our vacation in Ireland. There’s been the overplanning, overscheduling, overspending, and the trying to make sure that everything went perfectly — like that was going to happen. I had anxiety about whether I would pack too much or too little, whether I could sleep on the plane, whether I could find things to eat comfortably (after recovering from dental surgery). Anxiety about whether I could find help with my mobility challenges in the airports and at my destinations. Anxiety about driving on the left. Et endless cetera. As my therapist noted when I spoke to her after my return, it was good I took my anti- anxiety meds with me. (I made sure to pack them, even though I haven’t been taking them every day since consulting with my prescribing psychiatrist. I packed all my other psychotropics too, of course. I also carried my sleeping aid, which I’ve also stopped taking regularly, for the plane flights, but didn’t need it.) Many of the anxieties I encountered in Ireland did indeed have to do with driving. I tried driving the rental car once, but I was too nervous to continue that. My husband ended up doing all the driving and I navigated. After some bad experiences with the GPS unit that the car rental company provided, we switched to using Google Maps on my phone, both of which fortunately worked in Ireland. I was in charge of transmitting the directions to Dan and trying to translate kilometers into miles for him. The GPS took us on a series of narrow, stony roads that ended up with us running off the one lane and into a ditch. One of the first difficulties we had before we defaulted to Google Maps was when we were heading to our first bed-and-breakfast reservation. The accommodations were arranged in advance by the travel company, so I didn’t have to have anxiety about where we were going to sleep each night.) The GPS took us on a series of narrow, stony roads that ended up with us running off the one lane and into a ditch. After the initial shock and the realization that we couldn’t simply rock the car out of it, though, I wasn’t really all that anxious, perhaps because it was late at night and I was emotionally as well as physically exhausted. I had a flashlight in my purse (something I almost always carry). My husband took it and set off on foot to find help, while I waited with the car. In about half an hour he returned with a local couple of lovely, helpful people, who drove us and our luggage to the B&B (which was actually quite nearby). They also came back in the morning to pull the car out of the ditch and pulled out a minor dent for us, and they accepted a modest amount of Euros for all their help. All things considered, it could have been much worse. I fell into bed that night and slept soundly. During the whole trip, I never got really used to the driving situation. Dan noticed that I was making humming noises as we drove and bracing my hand on the dashboard (or the roof) at times. He called this “vibrating” and gently reminded me that I had the anti- anxiety meds with me. Eventually, I got used to taking them every morning before we began our day’s wanderings. My vibration was particularly noticeable when we passed another car, or when I thought we were swerving too close to the edges of the road (the ditch situation made this seem all too plausible). Parking in cities – and indeed simply trying to navigate in them – also triggered my anxiety . Then, there were the God-awful problems with our flights and our finances. Back in December, the airline had changed our flight out but never notified us about it, so we showed up at the airport four hours after our flight left. I spent several hours on the phone with the airline, our bank, and our credit card company trying to make arrangements for the first flight out the next day and the money to pay for it (since we were considered no-shows). Fortunately, I went into task-oriented mode (which I am sometimes capable of) and shuffled money and flights around before I collapsed. We did miss our scheduled first day in Ireland, though. Getting a flight back was even worse. There was a problem with our COVID-19 certification (we needed an antigen test, not just a triple-vax card) and later flights were booked solid. In the end, we had to spend two days in a Dublin airport hotel while trying to make arrangements with a dying phone and no charging cable. Dan came through there too when I was at the end of my proverbial tether and managed somehow to get a replacement. But by then, we were out of money and I had to ask friends and family to PayPal us money for the extra nights in the hotel. It was all quite nerve-fraying and close to panic-inducing. We’re back home now and I have settled down quite a bit, though I’m still dealing with financial repercussions, which have always been one of my major anxiety triggers. But I’m not taking the anti- anxiety pills daily anymore. And, as always, Dan is helping me. The good news is that, throughout and despite all this, we managed to have a great time in Ireland. Sure, I had anxiety – and quite a bit of it – but I was still able to enjoy the country, the scenery, the food, the activities, and the wonderful people. We’re already talking about saving to go back. For more, check out the Mighty Community’s list of tips for traveling with anxiety.

Janet Coburn

We Need Resources for Both Mental Illness and Substance Use Disorders

Not long ago, I noticed C-SPAN was going to be featuring testimony before Congress on mental health issues and legislation. I thought I’d see what was up. What I heard was a lot of questions about the opioid crisis and what the nation’s response to that ought to be. I tuned out and turned it off. I had been hoping to hear about issues such as insurance parity, access to treatment, assisted outpatient treatment, and more. Instead, what I got was a focus on substance use. I also recently saw a map that indicated which states had reimbursement programs for substance use disorders (SUD) and mental health initiatives. By far, most of the programs were for SUD. States that covered mental health conditions were in the minority, and most of them provided coverage for both SUD and mental illnesses. I’m not denying substance use is a problem in the U.S. or that legislative attention needs to be paid to it. I know the opioid crisis is tragically affecting individuals and communities across the country. Nonetheless, I wish as much attention was paid to other mental health issues as well. They affect individuals and communities, too. I was a little short-sighted as well as impatient, however. The two topics are not mutually exclusive. Mental illness and drug use are often comorbidities (also called co-occurring disorders or dual diagnoses). Still, there are in many places rehab facilities for people who abuse drugs and alcohol, and separate facilities for people with mental illness. The two conditions share many characteristics. Both can be attributed to brain chemistry. Verywell Mind notes, “[t]he activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.” The effects of brain chemistry on mental illnesses such as depression, bipolar disorder, and schizophrenia are not well understood and are even debated. But though the mechanisms of action on the brain may be different, there is little doubt the brain is involved in both addiction and mental illness. Medline Plus notes there are other similarities in possible causation, including genetics, stress, and trauma. Various psychiatric disorders are associated with substance use, including psychotic disorder, mood disorders, obsessive-compulsive disorder (OCD), sleep disorders, sexual dysfunction, and neurocognitive disorders. Despite this, PubMed has said, “In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.” One thorough, well-researched article with many sources listed is available from Mental Help. The latest version of the DSM recognizes the overlapping of substance abuse and mental illness, with substance-related disorders added to the DSM-5. Addiction Policy Forum reports: “The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.” The National Alliance on Mental Illness (NAMI) says, “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated — current thinking requires both issues be addressed.” They add that the treatment should consist of six elements: inpatient detoxification and inpatient rehabilitation, psychotherapy, especially cognitive behavioral therapy (CBT), medications (including those that assist in detoxification), supportive housing such as group homes, self-help, and support groups — whether faith-based or not. Of course, the idea substance use and addiction are diseases has not caught on with many members of the general public. They consider them to be personal failings or the result of having no self-control or hanging around with disreputable friends. Perhaps that is one reason public officials do not listen to those who promote changes in legislation to improve both substance abuse and mental health care. The intersection of addiction and mental health challenges is even more foreign. Advocates who contact their legislators are likely to be brushed off with a, “Thank you for contacting my office” letter. Politicians are also disinclined to listen to medical advisors on the subject, especially now that their attention is focused on COVID-19 policy. Perhaps those who advocate for more enlightened responses to substance use issues, mental health treatment, and dual diagnoses should start a little lower. Educating legislators is fine, but change is not likely to result until their constituents demand it. For one thing, advocates for reform could attend local city or county meetings to counter the pervasive “Not In My Back Yard” (NIMBY) response to treatment facilities. They could also educate their family members and friends about the realities of drug use, mental illness, and the intersection between them. When more people understand these ideas, they may be more likely to support legislative approaches that encompass them. Grassroots efforts such as Mothers Against Drunk Driving (MADD) have worked in the past to contribute to societal change and legislation regarding that problem. It may take a similar effort to achieve change in how addiction and mental illness are understood and treated.

Janet Coburn

We Need Resources for Both Mental Illness and Substance Use Disorders

Not long ago, I noticed C-SPAN was going to be featuring testimony before Congress on mental health issues and legislation. I thought I’d see what was up. What I heard was a lot of questions about the opioid crisis and what the nation’s response to that ought to be. I tuned out and turned it off. I had been hoping to hear about issues such as insurance parity, access to treatment, assisted outpatient treatment, and more. Instead, what I got was a focus on substance use. I also recently saw a map that indicated which states had reimbursement programs for substance use disorders (SUD) and mental health initiatives. By far, most of the programs were for SUD. States that covered mental health conditions were in the minority, and most of them provided coverage for both SUD and mental illnesses. I’m not denying substance use is a problem in the U.S. or that legislative attention needs to be paid to it. I know the opioid crisis is tragically affecting individuals and communities across the country. Nonetheless, I wish as much attention was paid to other mental health issues as well. They affect individuals and communities, too. I was a little short-sighted as well as impatient, however. The two topics are not mutually exclusive. Mental illness and drug use are often comorbidities (also called co-occurring disorders or dual diagnoses). Still, there are in many places rehab facilities for people who abuse drugs and alcohol, and separate facilities for people with mental illness. The two conditions share many characteristics. Both can be attributed to brain chemistry. Verywell Mind notes, “[t]he activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.” The effects of brain chemistry on mental illnesses such as depression, bipolar disorder, and schizophrenia are not well understood and are even debated. But though the mechanisms of action on the brain may be different, there is little doubt the brain is involved in both addiction and mental illness. Medline Plus notes there are other similarities in possible causation, including genetics, stress, and trauma. Various psychiatric disorders are associated with substance use, including psychotic disorder, mood disorders, obsessive-compulsive disorder (OCD), sleep disorders, sexual dysfunction, and neurocognitive disorders. Despite this, PubMed has said, “In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.” One thorough, well-researched article with many sources listed is available from Mental Help. The latest version of the DSM recognizes the overlapping of substance abuse and mental illness, with substance-related disorders added to the DSM-5. Addiction Policy Forum reports: “The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.” The National Alliance on Mental Illness (NAMI) says, “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated — current thinking requires both issues be addressed.” They add that the treatment should consist of six elements: inpatient detoxification and inpatient rehabilitation, psychotherapy, especially cognitive behavioral therapy (CBT), medications (including those that assist in detoxification), supportive housing such as group homes, self-help, and support groups — whether faith-based or not. Of course, the idea substance use and addiction are diseases has not caught on with many members of the general public. They consider them to be personal failings or the result of having no self-control or hanging around with disreputable friends. Perhaps that is one reason public officials do not listen to those who promote changes in legislation to improve both substance abuse and mental health care. The intersection of addiction and mental health challenges is even more foreign. Advocates who contact their legislators are likely to be brushed off with a, “Thank you for contacting my office” letter. Politicians are also disinclined to listen to medical advisors on the subject, especially now that their attention is focused on COVID-19 policy. Perhaps those who advocate for more enlightened responses to substance use issues, mental health treatment, and dual diagnoses should start a little lower. Educating legislators is fine, but change is not likely to result until their constituents demand it. For one thing, advocates for reform could attend local city or county meetings to counter the pervasive “Not In My Back Yard” (NIMBY) response to treatment facilities. They could also educate their family members and friends about the realities of drug use, mental illness, and the intersection between them. When more people understand these ideas, they may be more likely to support legislative approaches that encompass them. Grassroots efforts such as Mothers Against Drunk Driving (MADD) have worked in the past to contribute to societal change and legislation regarding that problem. It may take a similar effort to achieve change in how addiction and mental illness are understood and treated.

Janet Coburn

Bipolar Disorder: 5 Things I've Lost Due to Mental Illness

The quote from Mark Twain goes, “Of all the things I have lost, I miss my mind the most.” It’s a little annoying, at the least, when people repeat it. Those of us with psychiatric diagnoses don’t actually lose our minds, but we do often lose a lot of other things along the way. 1. We can lose friends due to our illnesses. I’ve certainly lost friends because of my bipolar disorder. I can think of two in particular who were very dear friends, but cut off all contact with me when I was at the depths of my depression and they feared I was suicidal. I reached out to them a few times and even sent them a copy of both my books, but got minimal response. I still miss them, though they now live in another state and it’s unlikely that we’ll ever see each other again, even in social settings we all used to frequent. 2. We might lose jobs because of our diagnoses. Twice I lost jobs largely because of my bipolar disorder. The first time, I had been isolating a lot, keeping the door to my office closed and barely interacting with any of the other employees. While an open door wasn’t technically a requirement of the job, I was the only editor who habitually hid behind a closed one, and it wasn’t taken well. I’m afraid I got a reputation as being difficult and uncommunicative. Finally, after several incidents where my emotions ran away with me, I was let go. The second time was at the job I had directly after that job ended. At first, I did alright in the department I was assigned. Then my boss left and the department was disbanded. I was transferred to another editing group, and there my difficulties began. The people there misunderstood my attempts at humor. My boss didn’t understand bipolar disorder and when she asked, “What does that mean?” I was caught off-guard and made a brief, unhelpful remark to the effect of, “Sometimes I have good days and sometimes I have bad days.” I could see her thinking, “What makes you different than anyone else?” Finally, I was put on probation, the only time in my entire career when that ever happened to me. I decided to leave before they could fire me. Then I went into a period of hypomania about not having to work there anymore and starting a freelance career, which did not turn out as well as I had hoped. 3. Our intellectual abilities can take a hit with mental illness. I know a lot of people worry that when they have a disorder such as bipolar, or even when they take medication for it, they will lose some of their brainpower. I never felt that way, but looking back, I can see the disorder also disordered my thinking. Moods of despair and exhilaration interfered with my cognitive functions. In addition to the general dulling of feelings during depression, I also lost the ability to concentrate enough to read — formerly one of my primary and best-loved activities. Even as I mourned the loss of my reading, I was simply unable to pick up a book and follow its contents. I took to watching mindless TV shows instead — really bad ones. 4. We lose enjoyment at the hands of our disorders. Just as I no longer found joy in reading, I no longer found other activities enjoyable or interesting as well. I used to love cooking, especially with my husband; but when depressed, I could barely microwave a cup of mac and cheese. I loved good conversation with friends, but I barely talked to anyone and ignored friends’ overtures. I enormously enjoyed traveling, but couldn’t summon the energy even for a day trip. 5. Mental illness can cause us to lose confidence. I used to be able to do all kinds of things by myself — attend business conventions (and science fiction conventions) and write articles for publication, for example. When I was struggling the most from bipolar disorder, I could do none of these things. When I went to conventions, I needed a bolt-hole and spent as much time as I could in my room. At that point, I couldn’t write about my condition or even send emails to friends. One of my friends said, when I was considering electroconvulsive therapy (ECT), “Write about it! That’s what you do!” But it wasn’t what I did anymore. Putting pen to paper — or words on a screen — was not even a possibility. I asked someone else if she would write about it instead. Things I haven’t lost. Of course, most of these things came back to me once I was properly diagnosed and medicated. I now read every night, write my blogs every week, travel here and abroad, and make friends I keep in touch with. I discovered some of my friends had stuck by me, even when I was in the depths. I still can’t work in an office, but I have found work I can do from home. I enjoy travel again. And if I’m a little slower to get a joke or find a word, it doesn’t bother me so much. I know my brain is just fine, except for occasional glitches. Losing all those things made me realize just how good my life is now that I am back to being myself. I have my mind back, if it was ever lost at all.

Janet Coburn

We Don’t Have the Right to Diagnose Public Figures With Illnesses

This question comes up all the time, about all kinds of public figures and various sorts of disorders. Does Donald Trump have narcissistic personality disorder? Did Freddie Mercury have undiagnosed bipolar disorder? Do the Kardashians have body dysmorphic disorder? Does Joe Biden have dementia? Was Nancy Reagan codependent? Seven years ago, I wrote about Emily Dickinson. I said it is impossible to know whether Dickinson or any other historical personage had any psychiatric disorder and, if they did, what it was. Now I have basically the same thing to say about the “diagnoses” of public figures. It’s impossible to say whether any given celebrity — or indeed any public or private individual — has a psychiatric disorder unless that person has spoken about it publicly. We cannot assume, just from the little we know about another person, that they live with any given condition. This is true not just of psychological disorders, but also physical ones. In the past, it was easier to keep physical difficulties secret. Few knew that John F. Kennedy wore a back brace because of an old injury or that Franklin D. Roosevelt used a wheelchair because of polio. In many cases, it is only now that their memoirs or the memoirs of their friends have revealed these previously secret afflictions do we know about them. When it comes to psychiatric diagnoses, the difficulty is not that friends may or may not keep a public person’s secret, but that the public has no real right to know unless the celebrity is open about it. The relationship between a psychiatrist and a patient is confidential. Only the patient can give permission for the doctor to disregard that confidentiality. Lately, it has become common for political figures to endure public examination of their medical records and even psychological records. But this is by no means a requirement for a public office such as president. Really, a president of the U.S. only has to be over 35 years of age, be a natural born citizen, have lived in the U.S. for at least 14 years, and get the most votes. And such scrutiny is hardly a requirement — completely irrelevant — for entertainers and athletes. Speculation about the private lives of public figures has reached the level of a sport. It seems that just because a person has achieved some measure of celebrity, their life is now an open book. Their fans (and detractors, for that matter) often want to feel they have a personal connection with the public figure. Many want to believe they know the celebrity better than anyone else. They may feel a kinship with the person because they have the same disorder the public figure supposedly has. But the most you can say about a public figure is that they show some behaviors that can be associated with a certain diagnosis — not that the person actually has that condition. Some celebrated sports figures and actors have been upfront about revealing their own and their families’ stories of psychiatric illnesses. Catherine Zeta-Jones, Glenn Close, Carrie Fisher, and Michael Phelps have let such conditions be known, in hopes of reducing the stigma surrounding mental illness and encouraging others to seek help for their conditions. But I believe these people are the exception. Most people, both celebrities and the general public, struggle in silence. Basically, the only way to diagnose a person is for them to have an ongoing relationship with a psychiatrist or psychologist. A doctor who has spoken to the individual and spent time with them is the only person who can make that diagnosis. Even psychiatrists who testify at trials about the mental state of defendants may not have had any previous, personal contact with them. Yet their opinions help determine the fates of people they don’t really know. Public figures don’t belong to the public, whatever their fans or detractors may think. Their minds especially are their own. It is reckless, improper, and ultimately futile to speculate on a public or historical figure’s mental state, in my opinion. But people do so and will continue to, as long as there are celebrities and people who feel they have a right to analyze them.

Janet Coburn

We Need Resources for Both Mental Illness and Substance Use Disorders

Not long ago, I noticed C-SPAN was going to be featuring testimony before Congress on mental health issues and legislation. I thought I’d see what was up. What I heard was a lot of questions about the opioid crisis and what the nation’s response to that ought to be. I tuned out and turned it off. I had been hoping to hear about issues such as insurance parity, access to treatment, assisted outpatient treatment, and more. Instead, what I got was a focus on substance use. I also recently saw a map that indicated which states had reimbursement programs for substance use disorders (SUD) and mental health initiatives. By far, most of the programs were for SUD. States that covered mental health conditions were in the minority, and most of them provided coverage for both SUD and mental illnesses. I’m not denying substance use is a problem in the U.S. or that legislative attention needs to be paid to it. I know the opioid crisis is tragically affecting individuals and communities across the country. Nonetheless, I wish as much attention was paid to other mental health issues as well. They affect individuals and communities, too. I was a little short-sighted as well as impatient, however. The two topics are not mutually exclusive. Mental illness and drug use are often comorbidities (also called co-occurring disorders or dual diagnoses). Still, there are in many places rehab facilities for people who abuse drugs and alcohol, and separate facilities for people with mental illness. The two conditions share many characteristics. Both can be attributed to brain chemistry. Verywell Mind notes, “[t]he activation of the brain’s reward system is central to problems arising from drug use. The rewarding feeling that people experience as a result of taking drugs may be so profound that they neglect other normal activities in favor of taking the drug.” The effects of brain chemistry on mental illnesses such as depression, bipolar disorder, and schizophrenia are not well understood and are even debated. But though the mechanisms of action on the brain may be different, there is little doubt the brain is involved in both addiction and mental illness. Medline Plus notes there are other similarities in possible causation, including genetics, stress, and trauma. Various psychiatric disorders are associated with substance use, including psychotic disorder, mood disorders, obsessive-compulsive disorder (OCD), sleep disorders, sexual dysfunction, and neurocognitive disorders. Despite this, PubMed has said, “In spite of the high association between substance use and psychiatric disorders, there is a surprising paucity of studies related to treatment and outcome. A few well-designed studies have been recently published and more studies of this nature are required in order to address the challenges posed in the treatment of dual disorders.” One thorough, well-researched article with many sources listed is available from Mental Help. The latest version of the DSM recognizes the overlapping of substance abuse and mental illness, with substance-related disorders added to the DSM-5. Addiction Policy Forum reports: “The DSM-5 has eleven criteria, or symptoms, for substance use disorders based on decades of research. The DSM-5 has helped change how we think about addictions by not overly focusing on withdrawal.” The National Alliance on Mental Illness (NAMI) says, “The best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder. The idea that ‘I cannot treat your depression because you are also drinking’ is outdated — current thinking requires both issues be addressed.” They add that the treatment should consist of six elements: inpatient detoxification and inpatient rehabilitation, psychotherapy, especially cognitive behavioral therapy (CBT), medications (including those that assist in detoxification), supportive housing such as group homes, self-help, and support groups — whether faith-based or not. Of course, the idea substance use and addiction are diseases has not caught on with many members of the general public. They consider them to be personal failings or the result of having no self-control or hanging around with disreputable friends. Perhaps that is one reason public officials do not listen to those who promote changes in legislation to improve both substance abuse and mental health care. The intersection of addiction and mental health challenges is even more foreign. Advocates who contact their legislators are likely to be brushed off with a, “Thank you for contacting my office” letter. Politicians are also disinclined to listen to medical advisors on the subject, especially now that their attention is focused on COVID-19 policy. Perhaps those who advocate for more enlightened responses to substance use issues, mental health treatment, and dual diagnoses should start a little lower. Educating legislators is fine, but change is not likely to result until their constituents demand it. For one thing, advocates for reform could attend local city or county meetings to counter the pervasive “Not In My Back Yard” (NIMBY) response to treatment facilities. They could also educate their family members and friends about the realities of drug use, mental illness, and the intersection between them. When more people understand these ideas, they may be more likely to support legislative approaches that encompass them. Grassroots efforts such as Mothers Against Drunk Driving (MADD) have worked in the past to contribute to societal change and legislation regarding that problem. It may take a similar effort to achieve change in how addiction and mental illness are understood and treated.

Community Voices

Bipolar Myths Debunked

Part 1 of 2 #BipolarDisorder is misunderstood by many. There are many helpful, reliable sources on the internet that explain it well and many books that provide both psychological expertise and personal stories of living with #BipolarDisorder . Still, the general public believes many myths about the disorder. Here are a few of them and the real information that can counteract them.

#BipolarDisorder is #BipolarDisorder is #BipolarDisorder . There are many types of #BipolarDisorder . The best known are #Bipolar1Disorder and #Bipolar2Disorder . But there are also #BipolarDisorder 3 and 4 – less well-known but still troubling versions of the disorder. #BipolarDisorder 3 is also called #CyclothymicDisorder . #BipolarDisorder 4 is #BipolarDisorder due to another medical or substance #Abuse disorder. Each of these types of #BipolarDisorder has differing symptoms – #Mania and #Depression for different lengths of time, for example – but they are not identical.

Hourly mood swings are symptoms of #BipolarDisorder . It’s common for people to say that their friend’s moods change rapidly, so they must have #BipolarDisorder . This is a misconception. #BipolarDisorder is characterized by alternating periods of #Mania and #Depression , but these last longer than hours or days. They can and do last for months or even years. There are types of #BipolarDisorder that are called rapid-cycling and ultra-rapid cycling, but these forms of the condition still feature episodes of #Mania and #Depression that occur up to four times in a year. There is (or may be) ultra-ultra-rapid cycling #BipolarDisorder , which can manifest over a day or two, but this is extremely rare.

You can “fix” someone with #BipolarDisorder . No, you can’t. My husband tried to fix me, with no success. Perhaps because he had some experience as an aide in a psychiatric facility or because he had once led a laughter therapy group, he thought he could. He loves me more than anyone ever has, but I was immune to his attempts. When he offered advice, I told him to “quit shrinking at me.” When he told the same joke over and over trying to get a laugh out of me, I just looked at him. Even a psychiatrist and medication can’t “fix” a person with #BipolarDisorder . They can help to alleviate the condition and even help a person go into remission, but there is just no fixing #BipolarDisorder .

#BipolarDisorder people end up hospitalized. Although some people with #BipolarDisorder are hospitalized, this is far from the only outcome for them, and many are hospitalized only for short periods. In fact, it can be very difficult to find a hospital or psychiatric facility when one is needed. The closing of many care facilities and the low number of beds available, along with insurance requirements, have contributed to this. Hospitalization is considered in emergency situations, such as when #BipolarDisorder persons are an immediate threat to themselves or others. Outpatient treatment is preferred for all but the most extreme cases.

Medication, particularly with lithium, is the only treatment for #BipolarDisorder . Lithium was the first medication to be used with #BipolarDisorder patients, but it is now far from the only one. Medication (with a wide array of choices) is certainly an important treatment for #BipolarDisorder , but there are others. “Talk therapy” can help people with #BipolarDisorder develop coping mechanisms and deal with mood swings. If medication doesn’t work, there are more avenues that can be explored. ECT (electro-convulsive treatment) has come a long way from the bad old days and the horrors depicted in Cuckoo’s Nest. TMS (transcranial magnetic stimulation) is another kind of therapy that has shown progress in treatment-resistant <

3 people are talking about this
Community Voices

Bipolar Myths Debunked

Part 1 of 2 #BipolarDisorder is misunderstood by many. There are many helpful, reliable sources on the internet that explain it well and many books that provide both psychological expertise and personal stories of living with #BipolarDisorder . Still, the general public believes many myths about the disorder. Here are a few of them and the real information that can counteract them.

#BipolarDisorder is #BipolarDisorder is #BipolarDisorder . There are many types of #BipolarDisorder . The best known are #Bipolar1Disorder and #Bipolar2Disorder . But there are also #BipolarDisorder 3 and 4 – less well-known but still troubling versions of the disorder. #BipolarDisorder 3 is also called #CyclothymicDisorder . #BipolarDisorder 4 is #BipolarDisorder due to another medical or substance #Abuse disorder. Each of these types of #BipolarDisorder has differing symptoms – #Mania and #Depression for different lengths of time, for example – but they are not identical.

Hourly mood swings are symptoms of #BipolarDisorder . It’s common for people to say that their friend’s moods change rapidly, so they must have #BipolarDisorder . This is a misconception. #BipolarDisorder is characterized by alternating periods of #Mania and #Depression , but these last longer than hours or days. They can and do last for months or even years. There are types of #BipolarDisorder that are called rapid-cycling and ultra-rapid cycling, but these forms of the condition still feature episodes of #Mania and #Depression that occur up to four times in a year. There is (or may be) ultra-ultra-rapid cycling #BipolarDisorder , which can manifest over a day or two, but this is extremely rare.

You can “fix” someone with #BipolarDisorder . No, you can’t. My husband tried to fix me, with no success. Perhaps because he had some experience as an aide in a psychiatric facility or because he had once led a laughter therapy group, he thought he could. He loves me more than anyone ever has, but I was immune to his attempts. When he offered advice, I told him to “quit shrinking at me.” When he told the same joke over and over trying to get a laugh out of me, I just looked at him. Even a psychiatrist and medication can’t “fix” a person with #BipolarDisorder . They can help to alleviate the condition and even help a person go into remission, but there is just no fixing #BipolarDisorder .

#BipolarDisorder people end up hospitalized. Although some people with #BipolarDisorder are hospitalized, this is far from the only outcome for them, and many are hospitalized only for short periods. In fact, it can be very difficult to find a hospital or psychiatric facility when one is needed. The closing of many care facilities and the low number of beds available, along with insurance requirements, have contributed to this. Hospitalization is considered in emergency situations, such as when #BipolarDisorder persons are an immediate threat to themselves or others. Outpatient treatment is preferred for all but the most extreme cases.

Medication, particularly with lithium, is the only treatment for #BipolarDisorder . Lithium was the first medication to be used with #BipolarDisorder patients, but it is now far from the only one. Medication (with a wide array of choices) is certainly an important treatment for #BipolarDisorder , but there are others. “Talk therapy” can help people with #BipolarDisorder develop coping mechanisms and deal with mood swings. If medication doesn’t work, there are more avenues that can be explored. ECT (electro-convulsive treatment) has come a long way from the bad old days and the horrors depicted in Cuckoo’s Nest. TMS (transcranial magnetic stimulation) is another kind of therapy that has shown progress in treatment-resistant <

3 people are talking about this