Knowledge is marvelous, but wisdom is even better.
There is always a part of my mind that is preparing for the worst, and another part of my mind that believes if I prepare enough for it, the worst won’t happen.
There was a fine-tuning of Richard's and my temperaments during the years we lived with his heart disease, lymphoma, and lung cancer. Before, our differences had triggered sporadic tension; now our basic natures served us better. Our sensibilities and quirks evolved into something more shared and complex, more mingled.
One of the advantages of science is that one's work, ultimately, is either replicated or it is not.
Many wish to believe that the odd is not so odd, the bizarre not so bizarre, and there is little changing of minds once they are set. There are only so many ways to understand the strange and disordered. The Greeks imagined gods to explain what they themselves could not. It is human nature to invent reasons for why the mind shatters, hope plummets, or the will to live dies. Scientific explanations are complicated and, for many, less humanly satisfying than visionary or religious ones. They are also less interesting than explanations based on planetary misalignment, toxins, or childhoods gone awry. There is a disturbing gap between what scientists and doctors know about mental illness and what most people believe.
There is no common standard for education about diagnosis. Distinguishing between bipolar depression and major depressive disorder, for example, can be difficult, and mistakes are common. Misdiagnosis can be lethal. Medications that work well for some forms of depression induce agitation in others.
Psychotherapy is a sanctuary; it is a battleground; it is a place I have been psychotic, neurotic, elated, confused, and despairing beyond belief.
One of things so bad about depression and bipolar disorder is that if you don't have prior awareness, you don't have any idea what hit you.
I have had manic-depressive illness, also known as bipolar disorder, since I was 18 years old. It is an illness that ensures that those who have it will experience a frightening, chaotic and emotional ride. It is not a gentle or easy disease.
Because I teach and write about depression and bipolar illness, I am often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential.
There are scientists all around the world looking for the genes responsible for bipolar illness and major depression.
It's more common than not that bipolar illness will start in the teens. One of the reasons I spend a lot of time on college campuses is exactly that reason. It's terribly important to talk to students about knowing these things in advance.
Lithium remains the gold standard, but many drugs now treat bipolar disorder. Medication is critical and should be combined with psychotherapy. Compliance is a major problem. Patients believe that once they're better, they no longer need the medication. It doesn't work that way.
I think one thing is that anybody who's had to contend with mental illness - whether it's depression, bipolar illness or severe anxiety, whatever - actually has a fair amount of resilience in the sense that they've had to deal with suffering already, personal suffering.
Several politicians and wives of politicians have been public about their experiences with depression or bipolar illness, including Lawton Chiles, Patrick Kennedy, Tipper Gore and Kitty Dukakis. Each made a tremendous difference by doing so.
Psychologists, for reasons of clinical necessity or vagaries of temperament, have chosen to dissect and catalog the morbid emotions - depression, anger, anxiety - and to leave largely unexamined the more vital, positive ones.
Lithium prevents my seductive but disastrous highs, diminishes my depressions, clears out the wool and webbing from my disordered thinking, slows me down, gentles me out, keeps me from ruining my career and relationships, keeps me out of a hospital, alive, and makes psychotherapy possible.
Confidentiality is an ancient and well-warranted social value.
An intense temperament has convinced me to teach not only from books but from what I have learned from experience. So I try to impress upon young doctors and graduate students that tumultuousness, if coupled to discipline and a cool mind, is not such a bad sort of thing.
No pill can help me deal with the problem of not wanting to take pills; likewise, no amount of psychotherapy alone can prevent my manias and depressions. I need both.
