May 13th, 2008 by Dr. Val Jones in Patient Interviews
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Therese Borchard is a vibrant author, editor, and mother of two. She writes a critically aclaimed blog called “Beyond Blue” at beliefnet.com, which is devoted to supporting people who are living with bipolar disorder. Therese’s writing is engaging and humorous, as she normalizes the experience of mental illness through her own lens of motherhood. Revolution Health salutes Therese for her compassion, and I hope you enjoy getting to know her through this interview:
*Listen to Podcast*
Dr. Val: Tell me about the circumstances surrounding your diagnosis of bipolar disorder. What was it like when you received the diagnosis for the first time?
Therese: I’ve struggled with depression most of my life, though college was when I first started taking medication and came to terms with the diagnosis of major depression. However, I had a much harder time when I realized that what I had was actually bipolar disorder. This was really difficult for me because my aunt was the only person I knew with bipolar and she took her own life when I was 16. So I had a lot of resistance to that diagnosis.
In fact, I ended up seeing 7 different psychiatrists, went through 2 hospital stays, and tried a total of 23 different medications.
Dr. Val: What’s the story behind the 7 psychiatrists? Were you not connecting with them?
Therese: I strongly advise people with bipolar or anyone struggling with depression to find the right doctor. For me it was going to Johns Hopkins, an academic center that has the best research and an outstanding team of doctors. My bipolar symptoms were not clear cut or “textbook” so it took a team of specialists to really help me find the best treatment path.
Dr. Val: What have you found to be most helpful (therapeutically) to keep you feeling balanced and in control?
Therese: My three staples are diet, exercise, and sleep, because I think that with any illness you just have to make those a priority. Obviously, finding the right doctor and the right medication is important too. Another key component to my recovery was connecting with a greater mission – I see that as my blog. Reaching out to others gives back to me every day. When I read a biography of Abraham Lincoln (he struggled with major depression, but didn’t have meds back then) I was struck by the fact that he focused on the emancipation of slaves as a positive way to get through his depression.
Obviously, a good therapeutic relationship with your doctor is important, as well as finding the right medications for you when/if needed.
I’ve found Dr. David Burns’ book, “Ten Days To Self Esteem” to be really helpful. It’s a work book that you can use as a journal. He asks you to list all your distorted thoughts, how they’re distorted and then how you can think differently. For example, we sometimes engage in mind-guessing, like “Oh he hates what I just said…” when the person isn’t thinking that at all. This book is really good for people with mood disorders.
I also regularly engage in prayer, and as a Catholic it’s really important to me and my healing.
Dr. Val: What advice do you have for people living with bipolar disorder?
Therese: You have to surround yourself with people who understand your illness because it’s so easy to be hard on yourself and adopt an attitude of “I should be able to get over this problem” and then feel deflated when it doesn’t magically disappear. It is so much easier when you have friends around to remind you that bipolar disorder is an illness like arthritis or diabetes – that it can be disabling and it’s not your fault.
Bottom line: Work as hard as you can on your diet and exercise, use light therapy as needed to help elevate your mood, and educate yourself as best you can about your illness.
Dr. Val: You mention diet as an important factor. Do you follow a special diet or do you just mean ‘healthy eating’ in general?
Therese: Mostly I’m talking about a healthy diet with lots of fiber, fruits and veggies, lean protein and whole grains. Caffeine and sugar are dangerous and alcohol can really mess up psych meds. Everything nowadays seems to have high fructose corn syrup in it. I try to stay away from highly processed foods and white flour.
Dr. Val: Do you believe that there is a stigma associated with bipolar disorder? How can that be reduced/removed?
Therese: The stigma does exist. I read a recent article about celebrities basically saying that antidepressants sap your personality, creativity, and sex drive. They make it sound as if people with bipolar disorder are doomed to live a dull and mediocre life. Other articles, like those about Britney Spears, are so negative. They make you think, “Oh God, this woman is never going to be normal.” The media really does bipolar disorder a disservice. Why not say that 70-80% of people with bipolar recover completely and do beautifully? They live very fruitful and productive lives. I have a hard time with how the media presents mental illness in general.
I also find that when I tell people that I have a therapist appointment their eyes sort of bug out. But it shouldn’t be shameful, it’s no different than going to a doctor’s appointment. We have to continue to work on tolerance and acceptance for mental illness.
Dr. Val: What role can online communities play in the management of daily life with bipolar?
Therese: Online groups have proven to be beneficial to those suffering from depression. Sharing your story is therapeutic in itself. Also the anonymity offered by online groups can make sharing stories and struggles more comfortable. For people who live in remote areas or who don’t have access to transportation, online groups offer the best way to connect with others.
Dr. Val: How do your coping mechanisms change when you’re struggling with mania versus depression?
Therese: Some of them are the same, like getting good sleep, eating healthy foods and exercising. I have two little kids so I watch the movie Cars a lot with them. And I like what one of the characters says in response to a question about steering around curves. He says, “in order to go left, you need to turn right, and in order to go right, you need to turn left.” I always remember this when I’m manic or depressed because it’s counter-intuitive.
When you’re depressed, the last thing you want to do is to get yourself involved in life, and get up and get moving – but that’s exactly what you need to do. When you’re manic it’s so easy to say, “This is so great, I’m on a roll, let’s go all night!” It’s hard to shut down your computer and say, “No, I’ve worked enough, now it’s time for bed.” But that’s what you need to do.
Dr. Val: Is there any bipolar-related information or service that you’ve always wished you could get from the Internet but doesn’t exist yet?
Therese: I wish there were an Amazon.com type directory online where you could find therapists, doctors, partial stay hospital programs, and support groups in your zip code, and read reviews from others about them. A one stop resource center would be great!
Dr. Val: You work at Belief Net – tell me a little bit about what the spiritual side of the bipolar journey. How has spirituality played a role in your healing?
Therese: I grew up as a very religious kid and my “OCD” made itself manifest at a young age. I remember that when I was in fourth grade I wrote a book for my mom and her prayer group friends about how to get to heaven. I look back and laugh at that now because it probably listed things like looking at the sacred heart and praying the rosary 15 times.
But on a more serious note, when I was deeply depressed and feeling suicidal the thing that kept me from taking my life was the thread of hope that God was there. If I didn’t have that I don’t think I’d be here. I often asked God for signs of His presence during that horrible times, and believe it or not, I always received them.
*Full Interview Available Via Audio Podcast*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 1st, 2008 by Dr. Val Jones in True Stories
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I was reading Keagirl’s latest post about a urology consult that she did in the psychiatric lock-down unit. Her patient was hearing voices – specifically that his left testicle was speaking to him. The good doctor was able to maintain a straight face through the exam and interview. There have been times when I suspect that my expression has given away my underlying feelings. A few of my awkward moments:
***
Dr. Val: Hello, Mr. R. I understand that you’ve had thrush in the recent past, and that your CD4 count has been as low as 25. Have you had any problems with thrush lately?
Mr. R: Oh, not at all. I found a way to cure it.
Dr. Val: Oh, very good. Tell me what works for you [expecting to hear ‘nystatin swish and swallow’ or ‘diflucan,’ I smile hopefully at the patient].
Mr. R: Well, basically since I started drinking my own urine the thrush has gone away.
Dr. Val: Oh… [pregnant pause] I see [scribbles note on clipboard as she takes one step back from the bedside.]
***
Dr. Val: [interviewing new patient in the inpatient drug detox program] So tell me a little bit about what brings you here today, Mr. S.
Mr. S: Well, you know, I have a real problem with crack cocaine, heroine, and alcohol.
Dr. Val: Yes, I see. Well, it’s good that you’re here now. [I smile genuinely].
Mr. S: But doc, I have to tell you why this all started.
Dr. Val: [Leaning forward, expecting a potentially important insight] Yes, what do you think is behind the drug addiction, Mr. S?
Mr. S: Well, I was born with a deformed penis and I think a lot of this has to do with my low self-esteem.
Dr. Val: Hmm. Well, I can see how that might be very challenging to overcome [eyebrows furrowing in a concerned expression mixed with mild awkwardness and some surprise].
Mr. S: I’d really like to show you what I’m talking about.
Dr. Val: Um… well, I uh… don’t think that will be necessary at this time. I trust you…
***
Nurse: [calling from psychiatric lock-down unit]: Is this the rehab consultant?
Dr. Val: Yes, I’m on call for rehab today.
Nurse: We have a man here with difficulty swallowing and we were wondering if you could take a look.
Dr. Val: Ok, what brought him to the psychiatric lock down unit?
Nurse: Well, he tried to kill a nurse at the transferring hospital – she got too close and he got a hold of her neck. But he’s not too hard to pry off because he has no eyes.
Dr. Val: No eyes?!
Nurse: Yeah, he cut them out several years ago during a psychotic episode. He used a piece of broken glass to gouge out his eyes and cut off his nose and ears too.
Dr. Val: Oh my gosh… that’s really terrifying. [Pauses with images of Silence of the Lambs floating through her mind] May I ask why he can’t swallow?
Nurse: I don’t know why he can’t swallow. That’s why I’m calling you.
Dr. Val: Well, I mean, how do you know he’s not swallowing? Did you see him choke?
Nurse: No he’s not drinking at all.
Dr. Val: Well, is there a cup next to him? Does he know it’s there?
Nurse: [silence]
Dr. Val: Ok, I’ll put him on my consult list…
***
You can’t make this stuff up.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 16th, 2008 by Dr. Val Jones in News
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We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
– The US Declaration of Independence, July 4, 1776
When I was in college I spent my summers working with mentally and physically disabled adults in group homes and camps. Many of the patients had IQs<75, which presented a unique communication challenge. Emotional outbursts were not uncommon as the adults used the only form of communication that seemed to draw attention to an immediate need. I spent a lot of my time trying to predict needs before frustrations bloomed, and after getting to know the peculiarities of each individual, I could generally keep the group in a fairly content state.
Most of the adults were on a long list of medications – some were for epilepsy, others were for heart defects, but many were antipsychotics and sedatives. At the time I didn’t realize exactly what each medicine was for, and wondered why these relatively young men and women needed so many pills.
In retrospect I believe that many of the medicines were a misguided attempt to control behavior. It’s analogous to giving someone, with their hand in a bucket of very hot water, a pain medicine instead of removing their hand from the bucket. And now new research in the Lancet suggests that antipsychotic medications (such as haldol or risperdal) do little or nothing to control aggressive behavior in the mentally disabled (though not psychotic) population.
So why have we been giving mentally disabled individuals antipsychotics for decades? Sadly, we thought that these pills would provide a quick and easy way to conform their behavior to our sensibilities, without having to get to know the reasons for their frustrations. And of course, these people weren’t intellectually sophisticated enough to question the utility of this approach or to decline the use of such medications.
I find it terribly sad that it has taken us this long to realize that giving anti-psychotics to mentally impaired people is not in their best interest. Surely more evidence would have been gathered prior to subjecting “normal” adults to such treatments. In this imperfect world, it does seem that those without a voice are less often heard. It is our responsibility as healthcare professionals to look after their interests and not take the easy way out. Mentally disabled individuals have the right to express themselves, and to be free of unproven and unnecessary drug treatments. Life, liberty, and the pursuit of happiness. Our own Declaration of Independence argues as much.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 11th, 2008 by Dr. Val Jones in Opinion
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Last night I watched the premier of VH1’s new “Celebrity Rehab” reality show with Dr. Drew Pinsky, an M.D. and popular TV and radio personality. Before turning on the TV, I had my own reservations about making a spectacle out of alcohol and drug addiction. But I hoped that the show would help to unglamorize the Hollywood drug culture and dissuade young men and women from idolizing bad behavior. As a physician who helped run a detox unit in New York City, I was also curious to see whether or not this “rehab” resembled real-world drug rehabilitation.
Overall, I was sorely disappointed. The only realistic part of the show involved actor Jeff Conaway (of “Grease” and “Taxi” fame), who was the most impaired and ill of the group. His speech and behaviors were typical of a man so wracked by drug and alcohol addiction that he needed a wheelchair for mobility. It was tragic to see him in such a self-destructive state, and witnessing his condition was a real wake-up call for anyone considering starting down that path. As for the rest of the stars, they seemed to be more interested in getting attention from the camera than turning their lives around and breaking their addictive behaviors.
The good
“Celebrity Rehab” may have some “shock value,” as it offers viewers some footage of individuals whose addictions have destroyed their lives. Although Jeff Conaway’s situation is certainly tragic and unappealing, the other stars still maintain some degree of “coolness” -which may be counterproductive for a young audience.
The bad
Overall, the dialogue is quite dull – which comes as no surprise since the individuals being videotaped were often inebriated or high on cocaine. The desire for true change does not come through in the celebrity stories, as best evidenced by a conversation between Dr. Drew and former professional wrestler Chyna (aka Joan Marie Laurer). Dr. Drew asks Chyna why she has come to “Celebrity Rehab,” and she responds with a shrug and says: “I don’t know.” Not compelling television.
I had the feeling that empathetic counseling is not Dr. Drew’s forte. In his attempt to show tough love mixed with detailed history taking, he comes off as aloof and uncaring. He is neither believable nor inspirational as a change agent. This disconnect makes it hard to believe that “Celebrity Rehab” is going to turn anyone’s life around.
Of course, the plush set, the comfortable celebrity quarters and the trendy clothing bear no resemblance to real drug rehab centers, where facilities are bare-bones and clinical and all patients wear standard uniforms. The lack of case managers, nursing staff and therapists was also notable – as the normal team approach was spun unconvincingly as a one-man Dr. Drew show. And of course, inpatient drug rehabilitation centers in the real world are NEVER co-ed.
The ugly
Some of the footage was so clearly contrived as to be annoying. Provocative pseudo “conflicts” were created in an attempt to maintain viewer interest. At one point, porn star (and attention-grabbing yet unrealistic 2003 California gubernatorial candidate) Mary Carey makes a fuss about having her dildos confiscated and then asks fellow patient Seth Binzer (lead singer of the rap-rock band Crazy Town) if he’ll have sex with her. This type of interaction really devalues the show and further undermines the credibility of the ongoing rehabilitation. Parents should wonder if exposure to this sort of material is more of a harm than a help to their tweens and teens.
In the final analysis, “Celebrity Rehab” has all the makings of a failure “me-too” reality show, relying on sensationalism to lure viewers. Recycled reality TV celebrities prance about the show in low-cut dresses while Dr. Drew makes uninsightful therapeutic gestures in a rehabilitation setting that’s not designed to truly affect change. I believe that drug and alcohol addiction deserves a more sincere and thoughtful analysis — something that an experienced documentary producer could achieve more effectively. I fear that the screenwriter’s strike will result in even more poor quality reality shows in the near term.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
January 3rd, 2008 by Dr. Val Jones in News
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A colleague of mine asked me what I thought about the recent New York Times article correlating household clutter with weight gain. It’s an interesting connection, so I thought I’d blog about it.
I think that clutter is probably a reflection of person’s emotional state, personality type, and upbringing. Some people seem to be more orderly by nature, others don’t focus on neatness as much. Some of us were trained to make our bed every morning, a few had a parent or nanny to do that. And still others have been “whipped into shape” by their spouse. Overall I think most of us prefer some degree of order over chaos, and given the choice would like to keep a fairly orderly home.
Now, what’s interesting to me is the emotional component in all this. We each have a certain level of baseline neatness, and we stray from that when we feel anxious, depressed, or exhausted. Think about what your house looks like now – is it at your natural baseline of orderliness? If not, are you more anxious, depressed, or tired than usual? I bet there’s a connection.
Many people gain weight when they’re anxious, depressed, or sleep deprived. So in a way, household messiness can be a marker for emotional distress. And it’s the emotional distress that fuels the weight problems. When a person is ready to lose weight, they’re probably motivated because they’ve managed to rise above their emotional concerns to achieve their goal.
So my point is this: take a look at your home to get a sense for how you’re doing emotionally. Are you anxious or depressed about something? Are you having relationship problems? Are you having difficulty sleeping?
Revolution Health has expert-led groups available to help you understand your emotions and how they influence your behavior. I think you will really benefit from getting into a discussion group and sharing your stories with others like you.
Here are some examples of groups that you can join right now (click to join):
Relationship Help – Mira Kirshenbaum, Counselor
Sleep Better – Steve Poceta, MD, Neurologist
Take Charge of Your Life – Ned Hallowell, MD, Psychiatrist
Lose Weight – Val Jones, MD, Rehabilitation Medicine
A Fit Family– Stacy Stryer, MD, Pediatrician
De-stress – Brad Jacobs, MD, Internal Medicine
Quit Smoking – Joe Scherger, MD, Family Medicine
Walk Your Way Thin – Jim Hill, PhD, Psychology
Maintain Your Weight – Chris Newport, Personal Trainer
Eat Right– Sandra Foschi, Nutritionist and Physical Therapist
Why not join a group? They may really help you to look and feel your very best this New Year. Not too many websites will offer this for free as Revolution Health does.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
