The age old dynamic of spirituality versus organized religion… Another Book About It

If you’ve been waiting for a book on this topic, it seems like Harris has synthesized it all, and that his book is a mixture of memoir and non fiction, which in itself is an interesting genre (I found a great book about insects by a naturalist that did this mix well), but none if it will seem new to anyone who has dropped whatever organized religion or religions they were surrounded by in favor of spirituality as the more inclusive and non violent non excluding of parts of the human race which all religions love to do (we are right and the others are wrong. Therefore we will force every in else to believe what we believe or we will consider ourselves “chosen” in some way and better and more worthy than everyone else…) that the term “spirituality” embraces. Spirituality has become a slightly meaningless word, or maybe a word that gets thrown around a lot especially in opposition to “organized religion”, but I like to think of it as a combination of the ideas of mindfulness, which leads to appreciation of what is in and around you in the moment, and the practice of loving kindness towards all other beings, ultimately with the goal of not arranging people and beings in some kind of hierarchy of importance, which all religions seem to do. The bible is filled with stories of getting rid of groups of “bad people” and saving others, even killing innocent babies born to the wrong people. So many stories of wiping out lots of groups of people and starting anew with a few, the Noah story repeated endlessly. Genocide it turns out, in the bible, is practiced by the character “God”.

Before I go on into more related topics and meanderings, here is the link to the description of this book and quotes from it: The book is entitled “Waking Up: A Guide to Spirituality Without Religion”

Neuroscientist Sam Harris on Happiness, Spirituality Without Religion, and How to Cultivate the Art of Presence

Mindfulness is not religious; it works well with science as it involves the practice of basic detailed observation of the world around you, as well as observation of your own mind and noticing what your senses are perceiving. It also involves observing your own breathing and even your heartbeat, all of which are quite obviously agreed upon types of realities. You need believe in nothing to practice mindfulness. And not magically but probably due to something that occurs in the brain that neurologists will be able to explain, loving kindness towards other creatures will eventually follow mindfulness practice. It has already been well documented that empathy and compassion when practiced release some kind of endorphins and make the person practicing it feel good, which is why it has survived alongside human beings’ great interest in ways to destroy themselves and others and the planet. So science is taking an interest in certain topics that are also entertained by spirituality. If you go at it from the point of departure of spirituality, which could be defined as some kind of meaning seeking or meaning making that humans engage in and basically through the perspective of individual experience, basically engaging in mindfulness type activities, versus the scientists working on ways to map the brain and observe what goes on in the brain and rest of the body during mindfulness activities, you can choose to try to engage in the actual experience or in the observation of it and mapping of the brain. In some way those two activities do intersect, as the scientist who is mapping the brain is probably engaging in mindfulness while observing someone else’s brain engaged in it…

I am not sure about the mysterious connection between being more awake and aware of the world around you and your presence in the world with the practice of compassion and loving kindness. Harris describes the discovery of this kind of compassion towards all creatures as something he observes feeling after taking the drug exctasy. Luckily you are not required to take any drugs to feel this kind of equanimity mixed with compassion and a melting of the concept of self and others. Ironically, the practice if mindfulness will eventually take you there, but it’s a slower more annoying and boring path. Mind altering drugs have been documented as the quick ticket to this kind of awakening and awareness of really taking in the present moment and feeling your mind and consciousness expand. There are other documented ways to go this route by depriving the body of food and/or sleep or exercising to an extreme point of feeling this expansion at the expense of your health. People have starved themselves and stopped sleeping to achieve a mind altering state of consciousness, probably since the first humans were around, just like there have probably always been some kinds of substances like peyote, magic mushrooms, extasy, LSD found in nature that humans have ingested and noticed a mind altering state of consciousness experience.

Anyway, the cheap, challenging and not fun but healthy route to experiencing a real awakening to regular old reality is to practice disciplining the mind through mindfulness exercises which can range from simple meditation (following your breath, noticing when your mind has run away, returning to the breath) or meditation in action which simply involves being as aware as possible of your present environment and of your mind and body in the moment. According to this practice of “observe and describe”, you can really have a “spiritual” experience. Look at Harris’ words, which are similar to the new “Positive Psychology” and Psychology of Happiness that has become a flavor of the moment:

“Most of us spend our time seeking happiness and security without acknowledging the underlying purpose of our search. Each of us is looking for a path back to the present: We are trying to find good enough reasons to be satisfied now.

Acknowledging that this is the structure of the game we are playing allows us to play it differently. How we pay attention to the present moment largely determines the character of our experience and, therefore, the quality of our lives.”

This is nothing new, it’s similar to what is said by Marsha Linehan in her writings and practice of DBT, Dialectical Behavioral Therapy, which combines the dialectic of total acceptance as the route to change, and which has a big mindfulness portion as part of its “practice”, as DBT is ultimately a practice that is not limited to teaching people with BPD, but a practice that all of us can benefit from. If you read about the mindfulness aspect of DBT, it will probably sound a lot like what Harris is talking about, with more specific types of exercises to help the individual become more mindful and aware of self and environment. Ironically, by listening to our senses and perceptions in our minds, we are observing both what is in the present moment and what is going on in our minds in the present moment.

In the end, all of this stuff is very simple, but very difficult to achieve. Try, for example, testing your ability to experience time in the present. Unless you are very super aware of seconds, you will either be living faster or slower than real time. You start a stopwatch, or look at a second hand, then sit and wait until you think a minute has passed and check the stopwatch or second hand. Has a minute passed? Did you think it passed and only half a minute went by or did a minute go by and more? I knew I would be the former, as I am aware that my inner motor goes too fast, so when I first tried this, only half a minute had gone by, no surprise! You would think that as therapists we have a good sense of time, at least in 50 minute chunks, but it is not true!

Roald Dahl wrote a great story called “The Marvelous Story of Henry Sugar”, which is all about the use of extreme mindfulness and concentration exercises which he originates with yogis. In this story, you can see how this type of exercise can be used for personal gain versus for helping others. What is so great about this story, is that he captures how the practice of mindfulness type exercises leads to a natural change in a human from selfishness and obliviousness of others’ suffering to great compassion. He takes the character of Henry Sugar, who is wealthy, lazy, bored and completely oblivious of himself and the world around him, and transforms him. What is truly great is that Henry Sugar reads a story that convinces him to try the practice of yogic concentration in order to see through playing cards so as to win at the casinos and make money easily by in essence a kind of “cheating”; he spends many months training his eyes and mind to see through playing cards. Because he changes his actual daily experience from one of wealthy meaningless pursuits spent with other wealthy people, to spending a lot of time alone, meditating and focusing on the middle of the flame of a candle and then focusing on a playing card and concentrating for hours every day until he starts to be able to see through the cardboard of the card and see the number and suit.

As he is practicing this and becoming obsessed with spending his waking hours basically in yogic training, he is changing a lot more than his ability to focus and concentrate on a playing card. I was very excited when he was ready to go to the casino, to see if he would right away have a weird response to the casino and the people there, which of course he did, as he had a heightened sense of observation and taking in the present moment, so the world he had been used to inhabiting was now transformed into something he was observing from the outside. Even more excititng, once he had carefully won a lot of money but sometimes lost on purpose so as not to draw attention to himself, he noticed that he did not feel the way he had anticipated. He was almost disappointed, and definitely not that excited to go winning more wads of money for the fun of it. The rest of the story was splendid; in the morning he woke up and started throwing twenty pound notes on to the streets and caused a huge commotion. A police officer goes up to his apt. and has an interesting encounter with him, basically telling him he is causing a public nuisance and that this is a stupid careless way to give away money. It turns out the police officer himself grew up in an orphanage and suggests to Mr. Sugar that he give his money to an orphanage. The rest of the story involves Henry Sugar engaging in a focused plan to travel the world’s casinos, winning Black Jack with his yogic powers to see through cards and starting orphanages in every country with all of his winnings.

Besides the fact that this story with a story within the story, the story Henry randomly picks up and reads, is so well written and engaging, this is a great story about how the practice of mindfulness techniqhes leads naturally to compassion, and Dahl takes an extreme example of a very limited uninteresting, selfish uncaring man who becomes transformed by simply engaging in exercises of focus and concentration, simple exercises that require a lot of discipline and patience though, into a totally different compassionate and purposeful human being. There is some connection between midnfulness practice, compassion, and the experience of meaningfulness or “purpose driven” living. This explains how Marsha Linehan helped many extremely suicidal individuals with terrible BPD illness go from a state of constant emotional pain, self harming, suffering, suicide attempts, to not just being able to get through the day without engaging in unhealthy coping choices, but eventually transforming their lives and finding meaning beyond the terrible pain of their illness.

It seems that it is really true that the only way to overcome or go through suffering to something on the other side is to truly embrace the present moment and accept all that it contains, being in it while observing it as neutrally as possible. A whole new post could be devoted to the connection between finding a neutral position on the moment and self acceptance and acceptance of others…

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Musing on Relationships, Culled from Marilyn Monroe’s Writings…

I am reading “Fragments” by Marilyn Monroe, which constitutes notes, poems, musings, diary entries, etc. I have long been fascinated by her for many reasons, psychological reasons being the obvious focus for this blog.
In publishing these fragments of writings in 2010, the editors and publishers wanted to show a very different side of this very complicated person, and they succeed. One of the interesting things about the photos in this book is that they show a lot of photos of Marilyn reading all kinds of books, and she was actually a voracious reader who tackled Dostoevsky and James Joyce’s Ulysses. It is even stated in the book that she liked having pictures taken of herself reading. This was no Sarah Palin pretending to read a newspaper. Those who were close to her knew she had a sharp curious mind and loved reading. Seeing these photos did make me reflect on present day actors as well as past ones. I couldn’t think of any who especially liked to be pictured reading. There is something interesting about a photo of a woman reading a book, especially this woman who was so in touch with the camera. In most photos of her she is looking at the camera, but in these she is dressed fashionably but casually and seen sitting or standing in a casual position in a homey looking environment, and her eyes are on the book, so there are two subjects to the picture. There is the mystery also of what page she might be on and what words age might be reading when the photo was taken!

Anyway, it is quite interesting to read her fragments, many of which are poetic and quite beautiful, while others are filled with insecurity, loneliness and the desire to improve herself. Some are even directly related to her being in psychoanalysis. I’ve been looking through the book for something to quote somewhere and finally found something for this blog rated to a recent post I wrote about relationships. It is very thought provoking and both sad, realistic and somehow hopeful, which is a curious combination, but not so strange when touching on the subject of childhood and attachment. So here it is; please react and comment if you are moved to do so…

“(page 131) re relationships

Everyone’s childhood plays itself out
No wonder no one knows the other or can completely understand. By this I don’t know if I’m just giving up with this conclusion or resigning myself-or maybe for the first time connecting with reality-

how do we know the pain of another’s earlier years let alone all that he drags with him since along the way at best a lot of lee-way is needed for the other-yet how much is unhealthy for one to bear.

I think to love bravely is the best and accept-as much as one can bear”
(words underlined in this passage: plays, much, unhealthy)

Quick reactions. I found this to be very truthful and really focused on relationships that are very mature and/or deep, those moments when people become unsure and unsettled by what they observe in themselves and their partner. It raises some interesting questions for couples who are examining their relationship or in couple’s therapy: “what are the parts of your partner that you do not know or want to know better but seem buried under a lot of pain?” ” Do you think you can share your own childhood painful parts with your partner, and if so, can you use this to better understand your child selves within the relationship?” “Do you give “lee way” to each other for all that emotional baggage you still carry?” “How much can you each bear of this part of yourself and of her/him?” “Are you afraid of it and avoiding it, or are you bearing too much of it to the point that either of you can recognize it is unhealthy?” “Or, are you asking too much of your partner and wanting ir demanding him/her to bear an unhealthy amount of this early pain in the relationship as it is right now?” “Do you feel that you love bravely and strive to accept what you can reasonably bear in each other?” “What does it mean for you to love bravely?” “Have you ever done it or do you shy away from it?”

As a side nite the word “lee-way” is quite interesting, with origins in the concrete meaning of a sideways drift if a boat or plane. The best definition I came across that seems to fit her use of the word was “leeway – a permissible difference; allowing some freedom to move within limits.” Just thinking about this word and this definition, well, what a perfect word to encapsulate a bug part if intimate relationships: the balance between acceptance and tolerance of difficult aspects of the other while at the same time having reasonable limits, thus capturing the combination of surrendering as well as separating/having boundaries… Real food for thought in just a few short sentences…

Mental Health Awareness Month Post Number 2!

Ok. I’m interrupting my attempt to get deeper into the issues around money and therapy because I have until the end of May to do my part in raising awareness around mental illnesses and the paths to mental health and stability…

I think this is too great an opportunity to pass up. On my personal Facebook I pledged to post at least once a day a fact or question to do with this subject. Then I decided to do the same on my LinkedIn “share” with connections. I am in too many professional LinkedIn groups to post on all of them! Then I decided to post about it on my public Facebook Artist Page. In fact after I’m done with this post I will announce it on my Artist Page.

I confess as a therapist and human who works closely with people on their very personal paths towards health and real soul fulfillment, feeling myself to be, or at least aspire to be, a sort of modern times Shaman or Doctor of the Psyche, I am really excited about this discovery that May has been Mental Health Awareness Month for over 50 years! How dare they not tell us in grad school or at our jobs and internships! How many therapists know about it??? Check with your therapist and/or psychiatrist to see if s/he knows about it! Spread the word! Thank goodness for the Internet and social media, as they help us raise awareness of such an important topic. There is just too much stigma out there about mental illnesses and so much ignorance. Why do health insurance companies still limit outpatient mental health treatment to 20 or 32 visits a year!?? How dare they set a limit on something so important in such an arbitrary manner! I’ve never had a patient with a mental illness who was invested in his or her therapy, who thought 20 visits or 32 sessions was enough per year. That has to change. What would people with one kidney do if they limited their dialysis visits per year? Unthinkable…

To get back to the point, though I don’t think I’ve strayed that far, in this post I will do what I’m doing daily on Facebook and LinkedIn: I’m going to make a list of ten questions or lesser known facts about various mental health issues. By mental health I include addiction, eating and personality “disorder” issues as well as trauma of various kinds and healthy positive behaviors related to this topic…

1. The relatively new phenomenon of personal blogs about how a person is living day to day with his or her symptoms and feelings about having some type of mental health issue is a wonderful way that people can see up close the courage and strength it takes for people to face their life day in and day out, struggling with staying healthy. It’s also a great testament to how far we’ve come with medications that work for people and with diagnostic criteria that help people come to terms with and manage their daily self care. Of course there is a lot more to improve with medication and treatment, but these very raw personal and honest blogs out there are a great way for people to feel less alone with their particular struggles. For some, the blogosphere is the only community they have and place they feel safe discussing such personal issues and struggles. So I start with a very positive aspect of mental health awareness by saluting all you people out there blogging about your struggles and triumphs. I follow many great blogs of this type and hope to find many more…

2. Schizoaffective Disorder: how many of you have heard of it? I first learned about it at an internship at a Continuing Day Treatment program long ago, so I have worked with individuals given this diagnosis. The term was first coined in 1933, but I have a feeling most people haven’t heard of it unless they have it, know someone with it, or work in the mental health field. You can find very particular detailed explanations of it on the Internet. I would describe it as bipolar and mood disorders meets and marries schizophrenia types of symptoms. What a challenge to be dealt this card! You have some sort of mood instability, whether primarily depressive, manic or both, as well as possible psychotic episodes, paranoia, hallucinations and delusions. For a really up close and personal account of it, read the memoir “The Quiet Room” by Lori Shiller. There’s still a lot of controversy about this diagnosis, and it comes up in this very moving book. In my experience, I think this diagnosis can be helpful to people suffering from such a confusion of symptoms because usually Bipolar Disorder and Schizophrenia thankfully now are seen and recognized and treated as very different because they are completely distinct. In the past people with either of these illnesses were lumped together , but we know a lot better now. However, there are some people who suffer from symptoms described by this “cross sectional” type of disorder. In my experience it really does exist, and the diagnosis is helpful, as people can be treated with both a mood stabilizer or anti depressant and an antipsychotic type of medication that people dealing with schizophrenia take, and they can have potential relief of their mix of symptoms and also begin to experience themselves as functioning at a much higher “level” in their lives which can be greatly improved and a lot less painful and confusing…

3. So, on the topic of mood stabilizers and “anti psychotic” medication, otherwise referred to as “psychotropic” medications: In contrast to what I said above, it can be confusing for people suffering from Bipolar Disorders, Schizoaffective Disorder, or other schizophrenia related disorders on terms of the wide variety of medications currently used to treat such illnesses. On the one hand, modern medicine has put to rest the confusion of what used to be called “manic depression” and “schizophrenia.” We all know now how different these are, but some of the medications treat both types. The difference is in the dosage. Old fashioned medications like Haldol, as well as the newer “anti psychotics”, such as Geodon, Risperidol, Seroquel, Zyprexa and many others, are prescribed for any form of psychotic episode, as well as being maintenance medication for schizophrenia and related “schizo” type disorders. To make matters more confusing, people with Bipolar Disorders, for whom a typical mood stabilizer like Lithium or Depakote, just to name 2 main ones, does not help enough to stabilize moods, can now take such medications as Zyprexa or Seroquel as mood stabilizers, usually on lower doses than for schizophrenia type symptoms. Some people with a kind of Bipolar Disorder take a typical mood stabilizer, as well as one of these other meds, and as well as an anti-depressant and other medications such as those for anxiety, which are in a totally different classification. So we’ve come all this way in distinguishing Bipolar type symptoms from those of schizophrenia related illnesses, and yet the same medications may be used to treat both. A little confusing. However, it is great that these other medications were discovered to have mood stabilizing properties, as some people need to take them instead if or alongside their regular mood stabilizers. Seroquel is also considered to have anti depressant properties, so probably some of the others like it also do.

4. While in my experience with working with people who suffer from very serious mental illness, mood stabilizers and medications like them can really be miracle workers for those suffering from Bipolar type issues in that, once the right medication or combination is found, people who take their medications daily can experience a great relief of symptoms and a sudden experience of real stability, those suffering from “unipolar” depressive illnesses such as dysthymia and major depression, tend to have more struggles with their medications. There are the lucky people who find the right anti- depressant and get relief; unfortunately of those people there is the group who after 6 months to a year find the medication no longer works, and they are plunged into a depressive episode and have to try some other anti-depressant(s) to see if a different one will work. For others, none of the different types of anti depressants out there seem to work. Some women in the latter group find a doctor who decides to try the more innovative treatment of using hormone medications to treat their depression. I read an interesting article about this a few years ago which really amazed me, as many people I know who suffer from mood disorders tend to complain that they can’t take birth control pills because it sets off depression. Others take hormones for birth control alongside their other meds without any trouble. Thankfully now there is a small group of women who take only hormonal medications to relieve their depressive symptoms! What a great medical breakthrough!

Ok. I have not yet reached number five and this post turned out to be much longer than I expected. So, the above is my food for thought on this topic thus far. I pledge to reach number 10 before Mental Health Awareness Month is up!!!

People Who Live with Mental Illness

I have talked about several memoirs of mental illness that I’ve found to be absorbing and brave. I just in fact read two by Marya Hornbacher, in reverse order of when they were written: “Madness” about her struggles with severe bipolar disorder and alcoholism, and “Wasted”, her first book about her serious long bouts of “bulimarexia” before she found out about the bipolar illness.
Anyway, I think one of the most challenging topics around mental illness, (besides acceptance that you “have” the diagnosis, which in itself is big and can take many years of illness for someone to finally accept it as a biological illness that needs to be treated with medication), is the day in day out living with your mental illness.
Many People are remarkably resilient and can return to their everyday lives quickly after a bout with psychosis, or an episode if some sort or relapse.

However the constant battle to stay stable and healthy, to keep up all the self-care required to keep illness at bay, that requires a dedication and perseverance of a rare sort. As these memoirs show, it isn’t enough to just be taking your medications as prescribed, although that is a big step forward, but usually, there needs to be some sort of consistent therapy and/or peer support group or group therapy. Along with that, people taking meds need to be aware of mixing them with alcohol and other substances. Part of regular self care involves regular exercise of some kind, engaging in soothing and relaxing activities, and eating healthily. Soothing self talk is key, especially for people hearing mean voices and those who have a running judgmental commentary going on in their brains. Many mindfulness meditation techniques are very useful.
For some, even after severe psychosis and several hospitalizations, life returns to “normal” and taking ones meds becomes like brushing your teeth. These people tend to take good care of themselves and push the mental illness to the side as they go about their day.

For others, it is quite the opposite. For example, for many people with eating disorders “under control”, there is a daily battle with the mind obsessing about body and/or food intake, and it can be frustrating to have mastery over the self destructive behaviors but not over the “sick” thoughts. For these people each day is a battle with their demons.
The same is true for many with bipolar disorder and schizoaffective disorder. Taking morning meds begins the day with the reminder “you have to watch yourself. Be vigilant. This could happen again…”
For these people just having or struggling daily with a mental illness can be exhausting. Self care plans can seem daunting and overwhelming. There is a certain kind of “burn out”, for lack of a better word, that occurs. This person is doing everything s/He is supposed to do. But, “I’m sick of dealing with this. I want it to go away. It’s too painful to try to be stable…” These kinds of thoughts can lead to suicidal ideation. In this case the fantasy of suicide is not directed outwards at wanting to hurt someone else by means of the ultimate form of self destruction, but is really a response to ones situation and being too drained and exhausted by the constant battle of ones own mind. For these people , every day starts with the profound ultimate choice:”Do I still want to live or am I ready to die and thus admit defeat over my illness.” S/hemust recommit to life every morning and choose the hard road of continued extra work, pain and exhaustion. Unfortunayely, once in a while the answer is clearly “no”, and then a well thought out suicide is planned. This is usually not the type of suicide “attempt” cry for help. In this case the person has already shouted and received help and support, but the illness wins over as it is simply too much to bear.

Psychological Memoirs Continued

Many of these memoirs have been made into movies. Most notable there are “Girl, Interrupted”, “Prozac Nation”, and “A Beautiful Mind”.

“Girl, Interrupted,” which came out in 1999, was based on writer Susanna Kaysen’s account of her 18-month stay at a mental hospital in the 1960s. I think I saw the movie before reading the book, which is unusual for me. I actually liked the film version and thought that it stayed pretty faithful to the memoir. In the story, Susanna was given the diagnosis of Borderline Personality Disorder, but it isn’t very clear that that was the correct diagnosis. The other characters in the memoir give a nice overview of a variety of issues that these girls got hospitalized for, especially the girl with the eating disorder who ultimately commits suicide when she gets out of the hospital obviously too early. Of course there is the great character played by Angelina Jolie who even won an Oscar for her performance. It is also a good period piece that portrays how different hospitals and society’s treatment of mental illness was in the 60’s as opposed to now.

“Prozac Nation: Young and Depressed in America: A Memoir”, written by Elizabeth Wurtzel about her struggles with depression while she was at Harvard was published in 1994. I do not remember if I have read the book or not, but the movie was ultimately disappointing despite some good acting on the part of Christina Ricci. The movie was released in 2001 and did not receive much critical acclaim, much less any Oscar nominations. I personally much prefer the psychologist and author Lauren Slater’s accounts of her own bouts with depression, which were covered in “Welcome to My Country” and “Prozac Diary” which came out 1998. Slater has always been a controversial figure in the community of psychology and psychiatry. The story of the controversy is well covered in the Wikipedia article about her many books and their reception. The fact that she stopped working as a therapist for the most part in order to focus full-time on her writing helps me deal with her unorthodox methods of discussing her own mental illness and her work with her patients. I get the sense that she is a much better writer than clinician. This is partly due to her strange boundaries. I remember reading an article of hers in Vogue magazine called “Divided Lives” which turns out to have come out in the January 1995 issue. If I remember correctly this is the article of her deciding to try an experiment and become friends with one of her patients who terminated the psychotherapy with her. As far as I remember, this experiment was a disaster, as one would have predicted. Anyhow, her depictions of her bouts with mental illness, including writings on her difficulties with pregnancy and medication issues are very interesting and well written. I think her metaphorical memoir of lying that I mentioned in my last post would actually make a great film. Christina Ricci might do well portraying Slater!

So “A Beautiful Mind”, which came out in 2001, technically does not go with these other films, as the book it is loosely based on is a biography (1998), not a memoir. However the movie’s portrayal of a man’s descent into schizophrenia seems to put it in the category of these other films as a biopic and portrayal of mental illness based on a real story. Many were disappointed in this film’s avoidance of John Forbes Nash’s homosexuality, and I would agree that it was a shame that the film steered clear of this part of his life. However, the film was very moving, and the acting by Russell Crowe was really stunningly great, from my point of view. While the film did not follow Nash’s real life closely enough, as a story of a young man’s descent into madness and semi recovery from schizophrenia, the film was excellent. The portrayal of the loss he felt when he on his own decided to reject his own hallucinations of, most notably, a young friend from college and a little girl, which seemed to be parts of himself that he could not internalize and integrate, this portrayal of the loss he felt while at the same time deciding to “ignore” them for his own health and sanity was a great commentary on an interesting issue about all kinds of psychosis. The truth is, people often do become attached to aspects of their psychosis, and then it can be a wrenching life or death decision to choose sanity and lose one’s very close companions, who have seemed very real to the person. There is a loneliness that follows, and even sometimes, people report feeling empty and flat without their invisible unreal companions, while at the same time they recognize that they have returned to sanity from a very dangerous inner world. This is a complicated and difficult crossroad which was very well and quite movingly portrayed towards the end of the film. In fact I found it to be the most important moment in the film. I found it a little hard to believe that genius Nash stopped taking any form of medication and used mind over crazy mind, so to speak, in order to remain sane. This seems highly unusual. I have worked with many people suffering from schizophrenia and schizoaffective illness as well as bipolar disorder, and these very biological illnesses almost without exception require quite a bit of medication to keep a person stable.it would be as though a person with diabetes decides to use her mind to control it instead of insulin…

In my last post on memoirs of mental illness, I failed to mention Styron’s brilliant memoir, “Darkness Visible”, a story of alcoholism and suicidal depression that interestingly comes late in the author’s life while he is in his 60’s, quite a contrast to the majority of these types of accounts which begin with the author having some kind of episode in their late teens or early twenties. Styron is a great writer of fiction, and this very personal non-fictional account of his struggles is really a great book for anyone to read and get a good glimpse into the world of depression.

“My Depression: A Picture Book”, written and illustrated by poet, children’s story writer and playwright Elizabeth Swados is also brilliant, as well as being quite funny, despite the serious topic and the writer’s very serious family history; both her mother and brother suffered from schizophrenia and both of them committed suicide. So this is a brave story of survival and a courageous battle with terrible depression. The illustrations are whimsical and delightful. She does decide to take medication and her treatment of this topic is great. I have worked with many adults suffering from depression, some of whom have taken medication for it as well as many who stopped their Ned’s or never decided to take them. This is a very controversial topic- medication for depression, as opposed to medication for the other mental illnesses mentioned above. Good topic for next week’s post…

Mental Illness Memoirs

There is now a whole category of memoir and autobiography genre that is called mental illness memoir or psychological memoir for lack of a better term. As I am interested in the memoir genre anyway, I have over the years read many fascinating memoirs and even graphic novels on these topics, first hand reports in the trenches of psychosis, mania, depression, borderline personality disorder, even one by a self proclaimed pathological liar!

At times they all seem to blend together: first there is childhood and background history and setting, then description of first “breakdown” or psychosis, subsequent hospitalization and/or treatment and recovery program, the transformation undergone by the author in recognizing, coping with, accepting her mental illness and/or addiction, the return to normal life that will never be the same, and how one deals with reentry into society or staying an outsider on the margins of society. There is also often discussion of the effect of mental illness on family relationships, where the author found support and acceptance and where not. In addition, there is often guilt about being mentally ill and draining family and friends- another common topic.

I would add here that in identifying the typical formulas of such memoirs, I do not mean to devalue them; in fact despite such repetition, I find it fascinating how each person has her own unique experience despite the similarities evident in these books and the movies made from them as well.

Obviously as a therapist I am fascinated with the unique and individual journey of a person over time and how the healing process can occur in so many different ways. Society’s constantly shifting attitudes towards mental illness also fascinate me. The courage involved in bearing your soul and describing intimate personal moments, even those you are ashamed of, is extremely admirable. And of course, when a large part of the book is taken up with the relationship between author and therapist, those are the most interesting memoirs. Case in point: one of my favorites called, “Get Me Out of Here: My Recovery from Borderline Personality Disorder”, by Rachel Reiland (a pseudonym), all about her struggles with anorexia and BPD. This book was great, as there is a lot of detail about BPD, especially the author’s awareness that identifying it and knowing she suffered from it actually helped her, and her courage and honesty do a great deal to erase the special stigma of this controversial diagnosis. As a therapist, what I liked most about this memoir was her focus on the long ongoing relationship with her therapist because she had great memories of sessions and was able to convey with great writing how reparative that therapy was for her.

So I find that Rachel’s book sets the bar high for this type of memoir. That is why I hate to say it, but I was not impressed by Mark Vonnegut’s memoir, entitled, “Just Like Someone Without Mental illness Only More So”. To be quite honest, I don’t even like or really understand the title. Is it meant to express just how good he was at going to Harvard med school and becoming a pediatrician despite his struggles with bipolar disorder and hospitalizations and this it makes him even more like ” normal” people? I just don’t get it. Having read really a lot of these memoirs, in comparison with a lot of ones that I liked or loved, this one did not impress me.

Before I continue to criticize this book, here’s a list of just a few of these books I found compelling and moving: “Drinking: A Love Story”, by Caroline Knapp- the title says it all!, any of Kay Jamison’s books but especially her personal struggles with bipolar disorder in “An Unquiet Mind” is a classic… Another classic psychological memoir also written by a therapist is Carl Jung’s “Memories, Dreams, Reflections”. Any of Lauren Slater’s many memoirs of her trips through depression and crazy land make for great reads, including “Lying” whose first words are “I exaggerate.” I also enjoyed “The Quiet Room: A Journey Out of The Torment Of Madness”, the only book I’ve read about schizoaffective disorder, by Lori Schiller and Amanda Bennett. Brooke Shields’ “Down Came the Rain” is brave, moving, personal, quite beautifully written and a pioneering book in this genre, the first of its kind about a “normal” person developing Post Partem Depression. The graphic novel I don’t remember but have on my bookshelf is “I’m Crazy”, by Adam Bourret, but obviously I don’t find it particularly memorable! These are just a few of a host of others. I should leave the movies on this topic for another post.

Getting back to Vonnegut’s book, the most recent one which I finished last week, I was very disappointed and I guess had an uncommon reaction to it, as it received a lot of great reviews. Someone called it the most insightful and enjoyable memoir he’s read in some time. Well not for me. Yes it was candid; all of these memoirs are. However, something was missing for me. I did not feel like I got a really good peak into his personal life or psyche. I got a good impression of his desire to be a doctor and brave foray into medicine, despite bouts with mental illness, but he seemed still almost shocked that he got into Harvard Medical School and got to be a pediatrician. I got no sense of his relationship with his psychiatrist or his feelings about medications or experience with them. This book just did not go that deep. I did not get that wonderful feeling of intimacy that I’ve gotten repeatedly from others of its kind. I was not moved and did not experience any profound feelings while reading it…

Stay tuned for a discussion of films of this type…