Tag Archives: bipolar disorder

Hope when it won’t get better?

Last night we ended our counseling & physiology class. All semester we have been looking at counseling through the lens of the body and its problems. All counseling problems are physiological since all counselees come with a body. But of course, some problems have more complex etiology and require counselors to understand how the body is part of the problem and solution. This semester we looked at a wide variety of problems: trauma, anxiety, addiction, sexual problems, bipolar disorder, autism, multiple sclerosis, traumatic brain injury, and much more. In addition, we explored how insomnia is the “mental illness multiplier” and some basic self-care and mindfulness provides much relief across all problems. And yet, we barely scratched the surface of the physical stuff we’d like to know.

But last night, we considered the problem of chronic illness, illnesses like chronic fatigue, fibromyalgia, and irritable bowel syndrome. Here’s the question I posed. What gives us hope when we no longer seek the removal or end of an illness? Most people come to counseling because they want to make their marriages better, end depression, find a new career, etc. But would you go knowing that all you can do is find marginal improvement and new ways to accept a chronic condition?

We discussed the unique problem of receiving endless advice (“Have you tried this? Have you considered that?”), the tendency to resist new ideas even while hoping a miracle will come along, and the fear that others will believe that your chronic condition is, “all in your head.”

Back to the question we asked, “What gives you hope when you don’t hope it will get better?”

Some answered that they found hope in finding other similar sufferers (though some danger in connecting with someone who only wants to vent). Others found hope in those who would be willing to listen and validate and help articulate lament. Still others found hope in those who would help them find just one more thing they can do to cope.

What would you find helpful and hope building?


Filed under christian counseling, christian psychology, Christianity, counseling, counseling skills

Lithium in your water? Might it be beneficial?

Here’s an interesting finding. A research team compared the top ten lithium-enriched regions of Austria (areas with naturally occurring lithium in the water) to the top ten lithium depleted regions of the same country. Those regions with greater naturally occurring lithium levels had statistically fewer suicides than those regions that had low naturally occurring lithium. The research does not prove a causal link between suicide levels and lithium levels in the water. It could be that there are better treatments or facilities in those regions. But, it does give you pause.

Lithium is, you may recall, a salt which is used to treat affective disorders like bipolar disorder. For many years doctors considered it the gold standard treatment. Many still do even though compounds like Wellbutrin and some anti-psychotics are also used to treat bipolar disorder.

While NO ONE is considering prophylactic use of Lithium (like we do now with fluoride in the water), this research does beg the question: at what point would preventative Lithium be appropriate? In other words, how many lives would need to be saved to make it something that we would want to give to everyone? Or, should we only give it to those who are deemed at-risk?

Assume for a moment that the cause for the lower suicide rate is the presence of Lithium in the water. Further assume that the research data is accurate in finding that the suicide rate in the Lithium enriched areas is 11:100,000 while the suicide rate in the depleted area is 16:100,000. I doubt that anyone would promote public distribution in order to save 5:100,000 but I do wonder what the number would need to be before anyone would recommend blanket addition to the water supply.

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Filed under Psychiatric Medications, Psychology

Serious mental illness and Christianity: Questions about responsibility

Today marks the end of the semester and the end of Counseling & Physiology. At the end of this course I ask students to talk amongst themselves regarding what they have learned in the course and what questions remain. The most frequent questions have to do with this:

What of a person’s struggles can be viewed as physiological; what is spiritual? What is the client responsible for?

[I should explain. We looked at problematic behaviors (e.g., cursing, aggression, etc.) after brain injury and the physiology of bipolar disorder. The class took bodily weaknesses quite seriously and recognized that sometimes our expectations of individuals exceeds capacity.]

At the end of this post I’m going to give you what I think are some better questions to ask. But first: Simultaneously, a couple of my old blog posts are getting a lot of attention these days–both having to do with the problem of serious mental illness, faith, and the response of the church. I highly recommend you skim the posts (both are incredibly short) but hang out with the comments.



These two posts are some of the most viewed and most commented on. Each and every comment reveals a world of heartache, alienation, and confusion about how one should think about mental illness, healing, responsibility, and the Christian faith. Clearly, we have not talked about this problem enough in the church–either to those with chronic mental illness or to their loved ones. Far too many are suffering alone.

Does it matter what of your problems are physical and what are spiritual?

Let’s say that you are a parent of a 3-year-old. Due to no fault of your own, your child misses their afternoon nap. It is now 6 pm and your child is both hungry and tired. She sees some candy and begins to whine for it. You know that you will feed the child in 15 minutes. You decline to give the candy and your child now has a temper tantrum. What do you do? Or, what SHOULD you do? You most likely provide mercy and kindness as you try to calm the child down. If the child screams, cries, and maybe even strikes you…has she sinned? Yes. Does it matter at the moment? Probably not so much as you acknowledge the child is limited by her lack of sleep.

Now, let’s extend the analogy. Would you treat your 40-year-old spouse in a different manner if they also had a tantrum because they were tired and they wanted dinner NOW? Of course, you would determine their moral capacity to be greater than the 3-year-old.

Back to our question…is it necessary to consider the division between spiritual and physical problems? Here’s why I think not. Problems are problems. Physical problems are spiritual problems in that we don’t do things only with our body and leave out our spirit. And spiritual problems always include the body. We don’t have spiritual experiences outside our neurons. Further, I still have to respond to the 3 or 40-year-old now (illustration above). Yes, I need to discern how to respond. Do I teach, comfort, discipline, rebuke, encourage? Am I responding with grace and mercy? Less important (though highly desirable) is my efforts in trying to keep the problem from happening again. Isn’t that really what is behind the physical/spiritual question: Who is going to make sure that x problem is taken care of?

Here are some better questions:

1. What can I do to help bring increasing comfort, hope, and encouragement–right now?

2. What response is my client capable of–right now (post hoc)?

3. What spiritual or physical interventions might be of help–right now?

4. How can I encourage my client to accept/respect their body (and its limits)–right now?

5. How can I encourage my client to see the hand of God in their life–right now?

6. What community resources and/or involvement can be made available–right now?

Notice the emphasis is on practical/mercy ministry, increasing insight, and commitment to seeing self from God’s point of view (rather than “normal”, “acceptable” as defined by church or larger community).


Filed under biblical counseling, christian counseling, christian psychology, Christianity, Psychiatric Medications, Psychology, Uncategorized

The impact of illness on marriages

One last nugget from the book Madness on the impact of serious illness on the marriage relationships. Marya explores the impact of her bipolar disorder on her second marriage and her very devoted husband who spent two years entirely focused on caring for her. When she begins to recover, she notices that he is rather a shell of himself.

In some ways it is simpler to be married to someone who is all need and no give. It’s an enormous drain. But there is benefit too: you become the hero, the center of someone else’s existence. You are the saint. You have, in this sense, a great deal of power. You tell this person what to do, and she does it. You feed her. You hold her, You are her mother, her father, her husband, her priest. And you are never required to her on an adult level. There is never anything wrong with you; any problem is caused by her, her illness, her meds not working, her malfunctioning mind.  …

You relish your role and resent it enormously at the same time. And when your role is upset–when the patient climbs out of bed and walks on her own, makes her own food, drives her own car…–you see she now does everything wrong….And–who does she think she is?–She doesn’t always agree with you…she doesn’t need you anymore. This is unacceptable. This won’t work. (222-3)

What she describes is oh so true. Whether mental illness, disease of some other organ, or impact of an affair, one spouse picks up the slack to make life work. And so it does for a time. But when the sick one gets better, when the alcoholic gives up the bottle, when the adulterer gives up the affair and wants to renew a partnership again, the “strong” spouse often then experiences rages, resentment, distance, etc. At the just the time when a partnership is possible–the thing that the strong spouse most desired and fantasized about, they find it now difficult to allow or participate in such a partnership.

Why is this? In part it is due to comfort in one’s role and the dislike for change. It is a changed belief that the “sick” spouse is now incapable of really being a partner. In part it is due to the the hidden belief of the unfairness of the previous imbalanced relationship and the desire for some level of payback.


Filed under anger, conflicts, marriage, Psychology, suffering

Madness revisited

Yesterday I made mention of Marya Hornbacher’s On Madness: A Bipolar Life. Nearing the end today and I continue to be taken with her capacity to illustrate the experience of mania, of using it to successfully do great things and of being drop-kicked into depression, of repeated hospitalizations, of the experience of being snowed under by medications, of chaotic and fearful thought patterns, of the impact on relationships and more.

She writes of the experience of ECT treatments and the struggle to regain her ability to think, write, relate, remember. After many treatments and lengthy hospitalizations, she reflects on her more stable mind:

Much is lost to those two year of hospitalizations. I remember very little, because madness erases memory, and so does electroshock.

…Memory is not all that’s lost to madness. There are other kinds of damage, to the people in your life, to your sense of who you are and what you can do, to your future and the choices you’ll have. But there are some things gained. The years that have followed my decision to manage my mental illness have been challenging, sometimes painful, sometimes lovely. The life I life, even the person I am, is nearly unrecognizable compared to the life I had when madness was in control. There are things in common,obviously–my mental illness hasn’t gone anywhere, and it still, to some extent, shapes my every day. But the constant effort to learn to live with it, and live well, has changed the way I see it, the way I handle it, and it’s probably changed me. (pp. 216-7)

The interesting thing is these sentences are not the last words or the “happily ever after” of the book. In fact, she goes on to tell how she unravels again and finds herself back in the hospital. Later, she confirms that it is hard to accept sanity as normal when it FEELS like failure. She desires normal to be the manic days. And then she reveals why. When her therapist asks why everything has to be perfect, why it’s okay for others to be “good enough” but not for her she says,

“It’s that your pretty good is better than my perfect”.

I suspect many of us can relate to that sentiment even if not bi-polar.

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Filed under book reviews, Psychiatric Medications, Psychology

A window into the world of bipolar disorder

As a teacher I am on the constant prowl for books, movies, pictures, etc. that give a realistic and personal view of the experience of mental illness. I picked up a great book regarding the world of the Bipolar I person: Madness: A Bipolar Life, by Marya Hornbacher (Houghton-Mifflin, 2008).

Marya tells of her life in short chapters beginning with her memories of life as a 6 or 7 year old. It is less biography and more of a sampling of her thought and emotional life. She has severe highs that last for a couple years, severe lows, and many rapid cycling from high to low in a matter of minutes. You can help but get a sense of her inner world from times in the hospital (many times at that) to impact of her medications and the ineffective care by several psychiatrists.

She is also author of “Wasted”, a book about her anorexia and successful treatment. Ironically, while on her book tour for that book she was drunk most days (trying to control her mania), impulsive in every way, and completely out of control.  

If you check out her book on Amazon, you can search inside. See if you can read pages 11-13 (search for the word “goatman”) and get a rich and painful flavor of her inner world in 1978.

If anyone here as read “Wasted” feel free to let us know what you thought of it.


Filed under book reviews, Depression, Psychiatric Medications, Psychology, teaching counseling

Science Monday: New Treatment for Mania?

The Harvard Mental Health Letter (v. 24:8, Feb. 2008) has a short blurb about a new medication being researched for the treatment of active mania.

Tamoxifen. Yes, the drug best known for treating and inhibiting the growth of estrogen sensitive breast cancers. Apparently it also inhibits an enzyme (protein kinase C or PKC) which may contribute to mania. The study lasted only 3 weeks and on a tiny sample of people (both males and females). But, there are positive signs that it stops active bipolar symptoms. 63% of those taking the drug improved, many within five days. Only 13% of those taking a placebo improved.

Side effects include hot flashes, increased risks for stroke and blood clots (known from its study in breast cancer patients). We will have to wait to see if it is useful just in bringing mania under control or also in long-term maintenance. Actually, we’ll have to wait a long time to see if it is ever used at all with manic individuals.

I do wonder about the back-story. How did this drug get targeted as a possibility. Was it in the lab or did doctors report that their actively manic breast cancer patients seemed to get better. That is how many of these discoveries get made. Viagra, for example, was first used to reduce hypertension. Turns out it was not particularly good at doing that. But, the men in the studies reported some other surprising and very desirable side effects.  Oh, if you can believe wikipedia, it also helps reduce plant wilting in cut flowers. Sorry, couldn’t help but add that little factoid.  

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Filed under counseling science, Psychiatric Medications