MENTAL HEALTH

Bipolar disorder


MANY FORMS OF MENTAL ILLNESS

A. The many manifestations of mental health problems like: neurotic and psychotic, personality and non-psychotic mental health disorders are now one of the leading causes of death globally.  One statistic sites mental health disorders as the second largest killer after heart disease by 2020.
  The world of statistics is a complex one, though, whether one is dealing with mental health or any one of dozens of other problems.  Readers with the interest, therefore, should question these statements here and others they find across cyberspace, and do more reading.  Still, there is little doubt that mental disorders account for a significant percentage of the non-fatal burden of disease.  As the tempestuous rage of modern society continues decade after decade in a multitude of forms, mental illness in a global perspective has become more common and, arguably, more serious than cancer, diabetes, or heart disease. 

Mental disorders can now be diagnosed reliably and accurately as can the most common physical disorders. Some psychiatric and non-psychiatric problems can be prevented, or managed and treated
with varying degrees of success, if people are willing to seek out the relevant specialists. It must be added, though, that this is only true if the country in question has in place some organized and advanced program of health care. With nearly 250 countries, independent territories, states with limited diplomatic recognition, and non-self-governing territories in the world and a total global population of some 7.4 billion people---this is often not the case.  Many countries still have a primitive, somewhat medieval health care system.

B. Health is a relative state in which one is able to function well physically, mentally, socially, and spiritually in order to express the full range of one's unique potentialities within the environment in which one is living. In the words of René Dubos, “health is primarily a measure of each person's  ability to do and become what he wants to become.” René Jules Dubos (1901-1982) was a French-born American microbiologist, experimental pathologist, environmentalist, humanist, and winner of the Pulitzer Prize for General Non-Fiction for his book So Human An Animal. He is credited for having made famous Jacques Ellul's environmental maxim, "Think globally, act locally." Jacques Ellul(1912-1994) was a French philosopher, law professor, sociologist, lay theologian, and Christian anarchist. Ellul was a longtime Professor of History and the Sociology of Institutions on the Faculty of Law and Economic Sciences at the University of Bordeaux. A prolific writer, he authored 58 books and more than a thousand articles over his lifetime, many of which discussedpropaganda, the impact of technology on society, and the interaction between religion and politics.  Go to:https://en.wikipedia.org/wiki/Jacques_Ellul

Dubos devoted most of his professional life to the empirical study of microbial diseases and to the analysis of the environmental and social factors that affect the welfare of humans. His pioneering research in isolating antibacterial substances from certain soil microorganisms led to the discovery of major antibiotics. He performed groundbreaking research & wrote extensively on a number of subjects, including tuberculosis,
pneumonia, and the mechanisms of acquired immunity, natural susceptibility, and resistance to infection. Aside from a period from 1942 to 1944 when he was George Fabyan Professor of Comparative Pathology and professor of tropical medicine at Harvard Medical School and Harvard School of Public Health, his scientific career was spent entirely at The Rockefeller Institute for Medical Research, later renamed The Rockefeller University.

B.1 In later years, Dubos explored the interplay of environmental forces & the physical, mental & spiritual development of mankind. The main tenets of his humanistic philosophy were: global problems are conditioned by local circumstances & choices, amd social evolution enables us to rethink human actions and change direction to promote an ecologically balanced environment. The future is optimistic since human life and nature are resilient and we have become increasingly aware of the dangers inherent in natural forces and human activities. We can benefit from our successes and apply the lessons learned to solving other contemporary environmental problems. For more on Dubos go to: https://en.wikipedia.org/wiki/Ren%C3%A9_Dubos

Dubos is often attributed as the author of the popular maxim "Think Globally, Act Locally" that refers to the argument that global environmental problems can turn into action only by considering ecological, economic, and cultural differences of our local surroundings. This motto appeared for the first time in 1978, six years after Dubos served as advisor to the 1972 United Nations Conference on the Human Environment. In 1979, Dubos suggested that ecological consciousness should begin at home. He urged creation of a world order in which "natural and social units maintain or recapture their identity, yet interplay with each other through a rich system of communications". In the 1980s, Dubos held to his thoughts on acting locally, and felt that issues involving the environment must be dealt with in their "unique physical, climatic, and cultural contexts". Dubos' approach to building a resilient and constructive relationship between people and the Earth continues to resonate.

B.2 For the academic years 1963–1964 and 1964–1965, during the first two years of my university life, he was a Fellow at the Center for Advanced Studies of Wesleyan University. He served as chairman of the trustees of the René Dubos Center for Human Environment, a non-profit education and research organization that was dedicated in his honor in 1980. The mission of the center, which was co-founded by William and Ruth Eblen, is to "assist the general public & decision-makers in formulating policies for the resolution of environmental problems & the creation of environmental values." Dubos remained actively involved with the Center until his death in 1982. He also served on the board of trustees of Science Service, now known as Society for Science & the Public, from 1949 to 1952.

Current views of health and illness recognize health as more than the absence of disease. Realizing that humans are dynamic beings whose state of health can change from day to day or even from hour to hour, leaders in the health field suggest that it is better to think of each person as being located on a graduated scale or continuous spectrum, a continuum, ranging  from obvious dire illness through the absence of discernible disease to a state of optimal functioning in every aspect of one's life. High level wellness is described as a dynamic process in which the individual is actively engaged in moving toward fulfillment of his or her potential.

C. Sometimes the problem isn’t that you’re unable to get a diagnosis but that you’ve received an inaccurate one. Mistakes are not uncommon: Autopsies performed on patients in one university hospital found that up to 32 percent of them had been given serious misdiagnoses. “If your treatment isn’t making you feel better, don’t immediately look for other therapies. Your first move should be to confirm that your doctor got the diagnosis right in the first place,” says Evan Falchuk president of Best Doctors. That typically involves sending all your records to an expert or, in the case of cancer, asking that a different pathologist examine your tumor sample. One of Falchuk’s clients, who was being treated for cervical cancer, discovered in this way that she actually had colon cancer that had spread to her cervix. Because cancer treatment is specialized, she had been getting the wrong drug. “It’s important to keep asking questions to ensure your diagnosis is right,” Falchuk says. “The worst that can happen is that your doctor may feel annoyed.”

My guess is that of all illnesses that medical science has to deal with at the level of the GP, and viewed from a planetary perspective, some 30% never get an accurate diagnosis, if any diagnosis at all. This applies to both mental health problems, & all other illnesses as well.  Most people haven't been educated by a physician about overdiagnosis, misdiagnosis, or no diagnosis. They are wary of ties to drug companies. Millions never see a doctor, but should.  Some 6% of the people of the world suffer from a rare disease.  In the UK for example, there are about 3.5 million people with a rare disease in a population of 65 million. In Europe, probably around 20 or 25 million people are affected by rare diseases. It's a huge number, but because there are so many individual rare conditions, each one only affects a relatively small population.

Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. The information required for diagnosis is typically collected from a history & physical examination of the person seeking medical care. Often, 1 or more diagnostic procedures, such as diagnostic tests, are also done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis. Diagnosis is often challenging, because many signs and symptoms are nonspecific. For example, redness of the skin (erythema), by itself, is a sign of many disorders & thus doesn't tell the healthcare professional what is wrong. Thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns. Occasionally the process is made easy by a sign or symptom (or a group of several) that is pathognomonic. Diagnosis is a major component of the procedure of a doctor's visit. From the point of view of statistics, the diagnostic procedure involves classification tests.
See: http://www.more.com/medical-mystery-diagnosis , http://www.dw.com/en/some-patients-never-get-a-diagnosis/a-18285411  For more on the subject of diagnosis go to: https://en.wikipedia.org/wiki/Diagnosis

A COMPLEX SUBJECT

A. In saying these things & making the above points, I do not doubt for a moment how complex this subject is. I also do not doubt how many millions of people with mental health issues are not being either diagnosed or treated.
For this reason, among others, I have posted part or all of what I call my 'chaos-narrative' at a number of internet sites. Readers will find below the beginning of my personal story, my experience of bipolar disorder (BPD) over the lifespan, if they click on the relevant links. This story has a special focus on the idiosyncratic manifestations of BPD in my life, my life-narrative, my experience with this and other mental health issues.

Severe mental tests are everywhere apparent, not only in the fields of psychiatry and clinical psychology, psychology & general medicine, specialist disciplines whose role is to deal with these afflictions, but also in society across the wider culture in which we all live. These tests have been afflicting people across most cultures in the long history of humankind.  This has become even more true in the last century as the world’s population has gone from 1.4 billion in 1916 to 7.4 billion in 2016, especially since the onset of the Great War: 1914-1918.  The tempests of our modern world have continued decade after decade and they show no signs of abating.  The accompanying tests and trials will continue to blow in the decades ahead, apparently with increasing force, as our planet goes through its several climacterics. 

According to the World Health Organization, 1 in every 4 people, or 25% per cent of individuals, develop one or more mental disorders at some stage in their life. Today, 500 million people globally suffer from mental disorders in developed and developing countries. Of these, 154 million suffer from depression, 25 million from schizophrenia, 91 million from alcohol-use disorder and 15 million drug-use disorder. 

B. Schizophrenia is a mental disorder characterized by abnormal social behavior and failure to understand reality. Common symptoms include false beliefs, unclear or confused thinking, hearing voices, reduced social engagement and emotional expression, and a lack of motivation. People often have additional mental health problems such as anxiety disorders, major depressive illness or substance use disorder. Symptoms typically come on gradually, begin in young adulthood, and last a long time.

The cause of schizophrenia is believed to be a combination of environmental and genetic factors. Possible environmental factors include being raised in a city, cannabis use, certain infections, parental age, and poor nutrition during pregnancy. Diagnosis is based on observed behavior and the person's reported experiences. During diagnosis a person's culture must also be taken into account. As of 2013 there is no objective test. Schizophrenia does not imply a "split personality" or "multiple personality disorder" — a condition with which it is often confused in public perception. The mainstay of treatment is antipsychotic medication along with counselling, job training, and social rehabilitation. More: https://en.wikipedia.org/wiki/Schizophrenia

These statistics and commentary are a world unto themselves, and readers with an interest in this subject can fine-tune their knowledge of the numbers in these several categories, in addition to the many other categories of mental health by going to the following links: http://en.wikipedia.org/wiki/Mental_disorder  and 
http://en.wikipedia.org/wiki/Mental_health  and  http://en.wikipedia.org/wiki/List_of_mental_disorders

BIPOLAR DISORDER

Bipolar disorder, also known as manic depression, is a mental illness that brings severe high and low moods & changes in sleep, energy, thinking, and behavior. People who have bipolar disorder can have periods in which they feel overly happy and energized and other periods of feeling very sad, hopeless, and sluggish. In between those periods, they usually feel normal. You can think of the highs and the lows as two "poles" of mood, which is why it's called "bipolar" disorder. The word "manic" describes the times when someone with bipolar disorder feels overly excited and confident. These feelings can also involve irritability and impulsive or reckless decision-making. About half of people during mania can also have delusions (believing things that aren't true and that they can't be talked out of) or hallucinations(seeing or hearing things that aren't there).

"Hypomania" describes milder symptoms of mania, in which someone does not have delusions or hallucinations, and their high symptoms do not interfere with their everyday life. The word "depressive" describes the times when the person feels very sad or depressed. Those symptoms are the same as those described in major depressive disorder or "clinical depression," a condition in which someone never has manic or hypomanic episode.  Most people with bipolar disorder spend more time with depressive symptoms than manic or hypomanic symptoms. For more on BPD readers can access many online sites, and I leave this for readers with the interest.  I have spent more time with manic or hypomanic symptoms. For some of the account of my experience: http://bahai-library.com/price_mental-health_history_autobiography-memoir

TO A DEGREE: JOHN NASH, SCHIZOPHRENIA AND BPD
 
All differences in this world are of degree, and not of kind, because oneness is the secret of everything.-Swami Vivekananda

Part 1:
 
For many people, interaction with others provides most of what they require to find meaning and significance in life.(1)  It is the place where virtually everyone meets people, forms partnerships and marriage, raises children, and earns a living, among a host of other activities.  For other people ultimate and the most significant of meanings are obtained from other sources.  Creative activity is a particularly apt, indeed, highly rewarding way to express oneself. Creativity is an activity that is often solitary, although group creativity is just as, or even more, common in this modern age. The productions which result from creativity are often regarded as possessing value to society but, of course, not necessarily.
 
In my life, beginning as it did in the 1940s, solitariness has been unavoidable and essential in one way or another, and so has human interaction. After more than fifty years of extensive interaction (1949-1999), I had come to the point in my lifespan where my employment, my interaction with others, and my health were causing me to feel an immense weariness, a certain tedium vitae, to draw on an old Latin phrase.   In the last year before I took an early retirement at the age of 55, I even had to take shots of testosterone to keep me going through my 15 hour days. Throughout the 1990s, as I headed into my final years of work as a teacher and lecturer, I increasingly felt the need for the solitary. I was moving, by sensible and insensible degrees, into a period in my life which I wanted to be characterized by a dominance of the solitary.  I also wanted to write. After the diagnosis of my pancreatic cancer in mid-2015 my social life has revolved around doctors and nurses.
 
Part 2:
 
After some forty years(1962-2002) of travelling-and-pioneering from place to place, and job to job, from one house to another, from one relationship to another, from deep and meaningful relationships to trivial, routine and difficult relationships, the time to finally stay in one place and, at the same time, to decrease the quantity of interaction with others seemed to have arrived.  I was not entirely sure but, at the age of 55, I took a sea-change, moved to a little town where that human interaction would be minimal, and I could get off what had become life’s old treadmill for 60 to 80 hours a week. I could cease my work in life’s several salt mines, so to speak. I wanted--as I say--to write and, gradually in the next decade, from 1999 to 2009, when I went on an old-age pension, I reinvented myself as: a writer and author, poet and publisher, editor and researcher, reader and scholar, online blogger and journalist.  As I write this on 8 March 2016, I have millions of readers in cyberspace, something quite unimaginable back in another age, even back in the late 20th century.
 
Back in the late 1990s I wanted, like Robert Redford, “to be a private man doing his own thing in a remote place.”(2)  Like Robert Redford, too, I had had trouble attaining this dominance of the solitary. Now, though, after ten years of retirement from: FT, PT and most volunteer work, 2007 to 2016, I have finally found that privacy, that remoteness and that solitary life. It is not totally removed from the social; until I was diagnosed with pancreatic cancer in September 2015 I visited in some dozen or more homes of friends over any 12 month period. I am also a husband & friend, father & uncle grandfather, Baha'i--roles with their inevitable & necessary social interactions. Until I was diagnosed with this terminal illness in September 2015 I was also the secretary and publicity officer of the local Baha'i community; these roles also brought other people into my home and me into theirs.-Ron Price with thanks to: (1)Sylvia Nasar, A Beautiful Mind: A Biography of John Nash, Simon and Schuster, NY, 1998, p.15; (2) Minty Clinch, Robert Redford, New English Library, London, 1989, p.3. For more on Nash: https://en.wikipedia.org/wiki/John_Forbes_Nash,_Jr.
 
There were always skads of people around
back then in ’49, in ‘59, in '69, again, & again. 
They were unavoidable, essential to my way
of life. I accepted them like the air we breath.

They’d always been there; it stayed that way,
in one way or another, until just the other day
when it became just me and my wife, my son,
my step-daughters, my grand-child, & some
other family members dropping in, many of
the good-byes to the Baha’is, lunch or dinner
with friends: the quiet life at last, at long last,
much the same as it had once been long ago
during those first memories of a lifespan….(2)
 
Getting closer to solitude, but never really
there, probably never really attainable, not
totally, for this commitment, this vision, is
all part of what Holley called: ‘this social
religion’ and social it is, with solitariness
only really desireable to a degree, a degree.(3)
 
(1) My son moved out of home about the same time that I had given-up all FT and PT work, about 2004. I was 60 in 2004.  My wife and I were alone for the first time in our marriage, with an empty nest, since our relationship had begun forty years before, back in April 1974. Between the first draft of this prose-poem in 1999, and its last in 2016, my son married; he and his wife had a daughter. One of my two step-daughters also had a child, and these new arrangements brought two more grandchildren into our lives. My second step-daughter also became a greater part of our lives with her two children and two more of our grandchildren.

(2) My first memory goes back to about 1947 or 1948 when I was an only child of older parents and my personal life was relatively solitary. In 1947 my father was 58, and my mother 43.

(3) I have been associated with the Baha’i Faith now for more than 60 years, and this world religion, and its highly social emphasis, brings me even now in touch with people on a daily basis in one way or another. I keep this interaction, as the age of 72 approaches in the next 4 months, to about one hour a day on average, not counting the time with my wife. Occasionally a friend or relative visits and, in recent weeks, a community nurse.

Ron Price
26/6/’99 to 8/3/’16.

PREAMBLE:
 
In 1998, the year before I retired from FT employment as a teacher and lecturer, Sylvia Nasar published, with Simon and Schuster, A Beautiful Mind: A Biography of John Nash. In October 2013, I watched the film that was based on this book and its subsequent screenplay. I place the following prose-poem below. It follows the above piece on the nature of the social-solitary continuum in my lifespan. The content of the following prose-poem also draws on that same biography of John Nash. For more on schizophrenia go to:https://en.wikipedia.org/wiki/Schizophrenia and affective disorders: https://en.wikipedia.org/wiki/Affective_spectrum  Bipolar disorder is on the affective spectrum(AS) and is a mood disorders. An AS is a grouping of related psychiatric and medical disorders which may accompany bipolar, unipolar, and schizoaffective disorders at statistically higher rates than would normally be expected. These disorders are identified by a common positive response to the same types of pharmacologic treatments. They also aggregate strongly in families and may therefore share common heritable underlying physiologic anomalies.
__________________________________________________________
Section 1:

A Beautiful Mind is a 2001 American biographical drama film based on the life of John Nash(1928- ), an American mathematician who won the Nobel Laureate in Economics in 1994, the year I began to eye my retirement from a half century of life as a student-and-teacher.  I won’t tell you about the film’s director or producer, its actors and the awards that the film won, or the money it grossed. You can read all that on the internet, if you are interested. The story, the film, begins in the early years of a young prodigy, John Nash, who arrives at Princeton university as a graduate student in 1947. Early in the film, in 1959 in fact, Nash begins developing paranoid schizophrenia. That was a big year; I was 15 in 1959, and the home-run king in a little town in a region of Ontario known as the Golden Horseshoe. That same year I also joined a Faith that claimed to be the latest of the Abrahamic religions.(1)

Nash endured delusional episodes while painfully watching the loss, and the burden his condition brought on his wife and friends. He went in and out of psychiatric hospitals until 1970, as I was planning to come to Australia from my home in Canada and work in the city of Whyalla in the state of South Australia as a primary school teacher. The film ends with Nash receiving the Nobel Prize in 1994. Like most biographical drama, the film takes considerable literary or poetic license with the story. It is the same with historical fiction. If people want more accuracy in the lives of those about whom personal drama and bio-pics are made, they have to go to biography; even then biographers have a certain stance, a certain take, on the person concerned. That is why some critics of the genre say that a true biography can never be written. For more on biography go to:https://en.wikipedia.org/wiki/Biography
 
Section 2:
 
In 2002 PBS produced a documentary about Nash entitled A Brilliant Madness which tells the story of the mathematical genius whose career was cut short by severe mental health problems. In Nash’s own words, he states:″I spent periods of five to eight months in hospitals in New Jersey, always on an involuntary basis, and always attempting a legal argument for release. It happened that, when I had been hospitalized long enough, I would finally renounce my delusional hypotheses. I would revert to thinking of myself as a human of more conventional circumstances. I would then return to mathematical research. In these interludes of, as it were, enforced rationality, I did succeed in doing some respectable mathematical research.”(2)
 
I took a special interest in this film because I suffered, during my 8 decades in the lifespan, from several mental health issues beginning with a mild schizo-affective disorder &, then, bipolar 1 disorder. In the now 300 page overview of my experience I mention several other mental health problems that I have had to deal with.(3) -Ron Price with thanks to: (1)The Baha’i Faith, (2)Wikipedia, 16/10/’13, and (3) Ron Price, 70 Years of A Chaos Narrative now located at several mental health sites.
 
Section 3:
 
Our auditory hallucinations
were on the same spectrum,
but yours lasted much longer
than mine with or without the
medications…I only got hit in
three major episodes, but the
ECTs & medications fixed me.

Problems with what is called
compliance were not as bad 
in my case. I thought that the 
film could have been more
accurate in its handling of the
treatment for schizophrenia.

The film’s use of the insulin shock
therapy frightened the pants off of
the millions in the population who
saw the film and gave psychiatry 
yet another pejorative public-image.

It would have discouraged people
with mental health disorders like:
schizophrenia, BPD, as well as other
mental health sufferers from taking
medication….thus simplifying what
is and was a complex health problem.
 
Ron Price
16/10/’13 to 8/3/'16.


COPING WITH PANCREATIC CANCER: REPLACING BPD AS MY MAJOR ILLNESS

The following is a long and somewhat complex account of my present, my retrospective and prospective, medical condition with pancreatic cancer. This account is intended to bring anyone who is interested up-to-date with my several illnesses as I head through the 8th month of the 72nd year of my life(14/3/'16) There is much that is left-out; I try to provide a solid core of information for readers with the interest. Readers are advised, though, to only skim or scan, search-out or slide-down to those portions of this annual letter or email which is of interest to them. For many, I simply advise that they stop reading now and, thus, save themselves wandering in a labyrinth of medical details about which they have little to no real care or concern, reason or regard for the content. For my BPD go to: http://bahai-library.com/price_mental-health_autobiography_history


Part A. On 1/3/'16 I entered my 7th month of dealing with pancreatic cancer. This ongoing and retrospective story,begun in late August 2015, can be read at several posts on this internet diary site. My battle with nausea is now largely managed; I am able to enjoy my day with some pleasure, although a deep fatigue is still part of my daily experience . I can read more and write a little, but still not much more than a page per day. A Community Nurse(CN) comes every day to give me a subcutaneous (SC) drug infusion by portable syringe driver(PSD). When this is not possible I go to the George Town Hospital(GTH) or the pathology unit of the GT surgery for the SC infusion. This has had a significant impact on my nausea management; indeed I have no significant nausea to speak of since mid-to-late February. Chris and I are also able to discuss with this CN any problems we are having in relation to our psycho-social worlds, in relation to each other, and in relation to our GP as well as the general management of this cancer. Occasionally the CN or a nurse from the GT pathology unit administers a blood test to assess the state of: my electrolytes, my iron levels, protein levels, neutrifils, and ESR(erythrocyte sedimentation rate). Readers wanting to know more about various terms/words I use in this statement should google their meaning. This post is just an outline, a general statement, as much for me as for any reader.

Part B: I will quote below a recent report of decreased morbidity(death during an operation) and mortality(death following an operation) following palliative surgery for patients with "irresectable pancreatic head carcinoma roux-en-Y hepaticojejunostomy"(the name given to my operation back in early September 2015). This report prompted/ contained a review in one study of 126 patients (whose median age was 64 (range 39-90) years) who had undergone palliative biliary & gastric bypass surgery, another name for my operation. The median hospital stay in that study was 17 (range 5-80) days. I have had 77 days in hospital by 8/3/'16. The median overall postoperative survival was 190(range 14-830) days. I have now had 7 months of the 27 months of life in the case of the best postoperative survival rate. This, of course, is the result from only one study with its 126 patients. In reality I have no idea how much more life is on my cards. Decisions about what we want to happen at the end of our lives are among the most personal, and the most important, we'll ever make. Yet all too many of us put off discussing this most sensitive of subjects until it's too late.

As a result people often don't get the end they would want. They also do not write about their experience and share it with friends who, for the most part, have little idea what the person in question is going through. I have given much thought to what you might call "the end game." This statement contains some of my thoughts. There has never been more help available to allow a person with a terminal illness to have the kind of care he or she really wants at the end of their life. With this terminal illness I am faced with this important subject every day. I write this statement partly for my own record & partly for those interested in my health, my current experience with this terminal illness. I send this account to others when it seems appropriate to do so. I'm sure some will find it too long, too many words and, in this case, readers are advised to skim, scan or just stop readfing when they lose interest.

Part C: In the hospital, palliative, & hospice care system that I now receive everyone is treated as an individual and the doctors & nurses have one overriding aim: to keep the person in question comfortable and give them the best quality of life possible. The CN and palliative care system(PCS) system is much more personal than the treatment I'd receive in the GTH. I also have access to an on-call doctor and/or a nurse at the GTH at night and in the day, respectively. There are a range of facilities I can draw on should that prove necessary when I need to go into some place other than my home for special care. The Melwood Palliative Care Unit(MPCU) at St. Luke's Hospital in Launceston is the most attractive and, when my wife needs a rest from the constant care she provides to me, I will get a referral from one of my Hospice-At-Home nurses for me to go into the MPCU.

The GTH is also available if I want care outside my home. In this case the referral will come from my GP. This system works on the principle that: "You matter to the last moment of your life, and we will do all we can to help you not only to die peacefully, but also to live comfortably until you die." This is at the core of the health and care system that I now enjoy as I go through this long illness/process. I may have to go into the hospital-or-care facility, like the MPCU, at some time during my illness in the months and years ahead. Time will tell.

Part D: I'll say a little about the use of a syringe driver(SD) in palliative care for treating nausea. This syringe driver is most frequently used in palliative care, particularly cancer care. I have had it used on my cancer since 1/2/'16. As I write this update on 14/3/'16 my nausea, as I say, has been successfully managed. This has been the case for at least the last 2 to 3 weeks. Problems associated with this device, this SD, are also discussed with each visit from a Community Nurse(CN). In the last 3 weeks a new butterfly was installed by a Community Nurse(CN) on 6 occasions. The cyclizine, the subcutaneous(SC) drug, came to be kept at the level of 100 mgs. Cyclizine is an antihistamine drug used to treat nausea and post-operatively following administration of general anaesthesia and opioids. A butterfly needle is a short needle with a small diameter attached to a thin, flexible tube. The needle is flanked by two rubber wings that allow the phlebotomist(a nurse or other health worker trained in drawing venous blood for testing) to grip and move the needle with ease. The tube is attached to a rubber boot that attaches to the blood collection tube. This SC drug will have an increased dose should I experience any greater discomfort, pain or simple anxiety.

Part E: Chris and I had a visit with my GP here in George Town, Dr Tim Mooney, on average once a week. On 9/3/16 he fitted me with a truss. I still have little energy to write, read and edit my writing. Quality of life is, for me, found in these activities. In the end, though, just being comfortable and nausea free is at the centre of my experience of this much used term, 'quality of life.' I settle for whatever reading and writing I am able to do in a day. I will continue to update this post as long as I have the energy and health to make alterations to this statement on a daily basis. Ascites, the buildup of fluid in the space surrounding the organs in the abdomen, is caused by cancer; doctors call it malignant ascites. Malignant ascites is most common in people with pancreatic cancer: it has come onto my agenda in the last week. People with ascites may experience the following symptoms all of which I have: abdominal swelling, sense of fullness or bloating, decreased appetite, ankle swelling & hemorrhoids.

On 11/3 my wife and I had a consultation with my GP about the symptom management/palliative care of this ascites. I need to reduce the amount of salt I eat, and not drink as much water and other liquids as usual. I got a script for a diuretic which helps reduce the amount of water in the body. It is spironolactone, a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. Spironolactone is used to diagnose or treat a condition in which you have too much aldosterone in your body. Aldosterone is a hormone produced by your adrenal glands to help regulate the salt and water balance in your body.

Part F: After 3 days on this new medication my symptoms have become less intrusive. I also got a script on 11/3 for loperamide hydrochloride which has inhibited peristalsis of the intestinal wall musculature & intestinal contents. It has reduced fecal volume, increased fecal bulk and, I trust, helped to minimize fluid and electrolyte loss. That visit with my GP on 11/3 also showed that my BP was low and I needed to increase my intake of protein. We discuss many things with my GP over the weeks: scripts, palliative care at the MPCU & the GTH for me, cyclizine, the nurses who come daily to change my syringe-driver, trusses, ascites, and we make an appointment to see him in 1 to 2 weeks.

Part of the services and care I receive is also available to my Carer, my wife. Chris has seen a grief counselor(GC) 3 times in February-March. The Department of Health and Human Services of the Tasmanian government Palliative Care provides this counselor. Grief and loss, although painful, are a very normal part of being human; however people suffering grief and loss can sometimes encounter difficulties. It is then that a GC is useful. I have yet to take advantage of such a person who is a social worker as far as I know. Grief and loss, although painful, are a very normal part of being human; however people suffering grief and loss can sometimes encounter difficulties.

Bereavement support is provided to the family and others who have a close relationship with the palliative care client registered with the Palliative Care Service(PCS). Bereavement support includes: individual support and counseling, family support and counseling, and referral to other support services. One such support service is Calvary Health Care Tasmania at St Luke's Campus Melwood Unit. It has spacious single rooms with an ensuite and fabulous views. They are tastefully refurbished to reflect a warm and friendly environment and include tea/coffee making facilities, microwave, bar fridge, flat screen TV and use of iPads. There is unrestricted visiting hours and friends and family are encouraged to spend as much time with the patient as both want, including overnight stays. A private hydrotherapy bathing suite is situated on the ward as well as a family room where patients and families can listen to music, watch a DVD or simply relax and have a cuppa.

ROBIN WILLIAMS: MENTAL HEALTH ISSUES?

ROBIN WILLIAMS
...a wake-up call for mental illness

Part 1:

News of the death of Robin Williams on 12/8/'14 stunned fans young and old. Comedians, actors, directors, many of the rich and famous who had been influenced by Williams paid their tributes. So, too, have millions of others now on social media in the first 48 hours since the first news of his suicide. Williams made his TV debut in the late 1970s TV comedy Mork & Mindy as a strange and lovable creature from outer space. At the time I had an 80 hour week with job responsibilities as a lecturer at what is now the University of Ballarat, and community responsibilities as the secretary of the local Baha'i community. I watched little TV in those years.

Williams had been open about his struggles with alcohol and cocaine & in the past months had entered a rehabilitation centre to help him maintain sobriety. But many questions remain over his final months & what could have led to his death. This post attempts to answer some of the questions that will arise. On the Hollywood Walk of Fame, dozens of fans congregated around Williams' star on Tuesday, 12/8/'14,  leaving flowers and candles to honour the versatile actor. Williams' appeal stretched across generations and genres, from family fare as the voice of Disney's blue genie in Aladdin to his portrayal of a fatherly therapist in the 1997 drama Good Will Hunting. Williams won the best supporting actor Oscar in 1998 for that portrayal. 

The 1998 movie, Patch Adams, in which Williams plays a medical student who battled convention to treat his patients using laughter, earned him a Golden Globe nomination. Some of the most humorous and touching scenes of Williams' from his favourite roles to his recipe for success can be found now in cyberspace. In 1998 I was just about to retire after a 50 year student-and-paid-employment-life, 1949 to 1999, and did not learn of the film until several years after I had taken a sea-change and an early retirement at age 55. In recent years I have watched more TV, at least two hours a day on average and have seen much of Robin Williams. With the arrival of pancreatic cancer since September 2015, though, my TV watching is now less than 1 hour per day.

Part 2:

Williams' career was launched in 1973 when he became one of only 20 students accepted into the freshman class at Juilliard and one of only two students accepted into the Advanced Program at the school; the other was Christopher Reeve. The Juilliard School is widely regarded as one of the world's leading music schools, with some of the most prestigious arts programs. In 1973 my teaching career had just begun to take-off when I was teaching in South Australia's first open plan secondary school. That same year I was hired to teach in Australia's first human relations training program for trainee teachers at the Tasmanian College of Advanced Education. Of course, I knew nothing of Williams back then and neither did the millions and billions who would come to know him in the next 40 years.

Williams said that the favourite role which he played was Oliver Sachs in Awakenings.  He said that he saw the role as a gift because he got to meet Sachs, and got to explore the human brain from the inside out.  "Oliver writes about human behaviour subjectively," said Williams, "and that for me was the beginning of my fascination with human behaviour." "In his stand-up specials and chat-show appearances," wrote a reviewer in The Economist, "he never seemed to hold anything back.  Dripping with sweat, pouring out words in torrents, he seemed to have no filters between his buzzing brain and the outside world.  He could be endearingly open and honest about his own problems, his addiction to alcohol and cocaine, even while improvising delirious flights of fancy and flitting from character to character. Viewers loved him for it. Mr Williams had a versatility that few comedy superstars have matched."1 

Part 3:

In June 2014 Williams spent time in the Hazelden Addiction Treatment Center in Minnesota, which helps patients maintain long-term sobriety. The death of Williams shook Hollywood, & colleagues mourned the loss of what many called a big-hearted man & one of the most inventive comedians of his time. "Robin Williams'  suicide doesn't cross the line, but it comes very, very close to it," said Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention(AFSP). "Suicide should never be presented as an option. That's a formula for potential contagion. Adolescents are most at risk of suicide contagion; in recent years, groups like AFSP have also become particularly attentive to the role the internet plays in romanticising notorious or high-profile deaths, something it has long asked both the news and entertainment industries to avoid.

One family acquaintance was quoted in the Los Angeles Times as follows: "Williams always had this sadness about him, this melancholy.”  He had never been diagnosed with clinical depression or bipolar disorder which is not to say he did not suffer from the ravages of these mental health issues.  He had the money to afford the best treatment, but the sad truth is that, in some cases, even the best isn’t enough to save people." Mental health is a highly complex subject. I know a little about the subject having had to deal with depression and bipolar 1 disorder for over 70 years. 

Part 4:

According to government statistics compiled in 2010, 60 percent of Americans with mental illness got no treatment within the previous year.  People reported a variety of reasons—they couldn't pay for it, they thought they'd be fine, they didn't want others to learn about it. Even if that 60 percent figure is exaggerated, and even if conditions have improved, the problems are still widespread. And they are obviously not confined to the USA. Although we’re accustomed to hearing about artists and their hidden "demons," Williams was such an effervescent, joyous presence that his struggles could put into sharper relief just how life-altering and devastating mental illness can be.  They also put into sharp relief the seductive and insinuating quotient that is mental illness and, more so, when addictions and the frenzy of renown, celebrity, are mixed-into the equation. If he couldn't conquer it on his own, who could?  The lesson would be, could be, one last, great contribution from an artist who has made so many contributions already.

The factors behind his suicide have been speculated upon endlessly as colleagues and friends of Williams came forward to allege that depression contributed to his severe mental state. But his widow Susan set the record straight. “It was not depression that killed Robin,” Susan told People magazine in one of her first interviews since losing her husband. “Depression was one of let’s call it 50 symptoms, and it was a small one.”  She argued that it was a debilitating brain disease called diffuse Lewy body dementia or dementia with Lewy bodies (DLB) that took hold of Williams, and probably led him to suicide. For more go to: http://www.theguardian.com/film/2015/nov/03/robin-williams-disintegrating-before-suicide-widow-says  and https://en.wikipedia.org/wiki/Robin_Williams
 
"A quarter of the population suffers from mental health issues that could potentially drive suicidal thoughts," Moutier said. "This is a very important issue, from a public health standpoint, and one we need to bring to light."2-Ron Price with thanks to 1 The Economist, 12/8/'14, and  2The Washington Post, 13/8/'14.

Part 5:

It is my understanding
from what I have read
about you, Robin, that
you never received the
diagnosis....depression
and bipolar disorder..I
can hardly believe this!
 
Your addictions and your
health problems certainly
seem to indicate at least a
variety of bipolarity that is
known as cyclothymia, and
depression.  I look forward
in the weeks ahead to reading
some of the analyses of what
the mental health issues that
you faced. Your death gives
society a wake-up call to deal
with mental health problems,
alcohol & the many addictions.

Ron Price
13/8/'14 to 15/3/'16
 
 JAMES BOND AND ME: mental health

A.O  JAMES BOND AND I GO THROUGH THE STRATOSPHERE: SUB-TEXT: MENTAL HEALTH
 
Ian Fleming, the creator of James Bond, went through the financial stratosphere in 1962 when the film adaptations of his fictional spy began appearing. I began my travelling-pioneering life with the Canadian Baha’i community in ’62 and did not see a Bond film until 1967. The books of Ian Fleming had gradually become famous as they had been appearing since 1953, the year that the Baha’i community completed the temple in Chicago.  Ian Fleming was a restless, cynical English newspaperman who began publishing his Bond books with Casino Royale and with the words: “The scent and smoke and sweat of a casino are nauseating at three in the morning.” Fewer than five thousand copies of that book were initially printed, but sales rose with each book. Bond slowly entered the national consciousness, and his adventures began to travel, notably to America.(1)

Half a dozen more books were to come before Fleming died in August 1964, and there was a handy endorsement when John Kennedy revealed his enthusiasm for 007. I was just about to start my honours history and philosophy course at McMaster university and a part time job with the T. Eaton Company in their cash register clearance section when Fleming died. I was the only Baha’i on campus in my university years: 1963-1966 and readers can examine my autobiography should they be interested in my life from 1943 to the present.  The tumult of my bipolar disorder kept my emotions in a confused state and I never even heard of the books of Ian Fleming back then. -Ron Price with thanks to (1) Geoffrey Wheatcroft, Bondage, The New York Review of Books, 14 August 2008.

A long and distinguished line of adult 
spy fiction books runs from Conrad’s 
The Secret Agent by way of Somerset 
Maugham’s Ashenden books to Greene, 
Eric Ambler, Nigel Dennis, John Le Carré, 
and Robert Harris, with those Americans 
Alan Furst and Joseph Kanon latterly……
carrying on the tradition.(1) But, I must
confess to not being interested in spy
fiction of any kind……Fleming drank a 
bottle of gin a day & smoked so many 
cigarettes that he died at only fifty-six.

His story grew still more melancholy &
his only son who had an acute bipolar 
disorder took his life with an overdose 
of drugs and, as a sufferer from bipolar 
disorder myself, I can tell you that drugs 
& manic-depression do not mix especially 
with all that money to support your habit.

1 Wheatcroft, op.cit.

Ron Price
14 November 2011


A. James Bond is one smooth mother lover. How does he do it? That is, how does he so seamlessly navigate multiple women, spy on Russian warlords, and win every game of Poker all the while remaining calm, cool and collected with a cigarette in one hand and a cosmopolitan in the other? Granted, Bond is a fictional character. Jared DeFife is spot-on when he notes that psychologists love analyzing fictional characters. Jared DeFife, Ph.D., is a clinical psychologist and relationship therapist in private practice in Atlanta.  He is also an Adjunct Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. Dr. DeFife is also the host of the School of Psych podcast, featuring insightful interviews with experts and stories about psychology, culture, relationships. Available now from iTunes. Offering thoughtful interpersonal and emotional change, Dr. DeFife specializes in working with "love-stuck" couples and individuals struggling with break-ups, infidelity, relationship conflicts, and commitment crises. He also offers clinical consultation services for enhancing clinical practice and development for clinicians/counselors/therapists.

But double agents do exist. And so do ordinary people who have the Bond psyche, or least have it at their disposal and can turn it on and off depending on their goals. But what exactly is the Bond psyche? Dr. Jonason and his colleagues have referred to the Dark Triad, the combination of Machiavellianism, sublinical narcissism, and subclinical psychopathy, as a "James Bond psychology": Go to these 3 links for more: (1) https://en.wikipedia.org/wiki/Machiavellianism , (2)   https://en.wikipedia.org/wiki/Dark_triad and (3)   https://books.google.com.au/books?id=EujCCAAAQBAJ&pg=PA37&lpg=PA37&dq=subclinical+psychopathy+wikipedia&source=bl&ots=tNEDaCHYf9&sig=TZ0INZbF5uf7kO-IFwSLXG1loUk&hl=en&sa=X&ved=0ahUKEwjsy-Xj5sHLAhUM6WMKHaDtBkUQ6AEIWTAO#v=onepage&q=subclinical%20psychopathy%20wikipedia&f=false

A.1 THE DARK TRIAD

In a recent paper called "Who is James Bond?: The Dark Triad as an agentic social style", the author set out to determine the "particular constellation of personality traits and behaviors that enable those high on the Dark Triad to maneuver themselves into relationships with others & take advantage of others." While acknowledging that clinical levels of the Dark Triad traits are certainly socially undesirable, Dr. Jonason and his colleagues argue that the traits that underlie the Dark Triad, which are partially independent but moderately related to one another, are best viewed as one particular social orientation towards others and may facilitate people's goals, especially when those goals involve an exploitative social strategy and a short-termmating strategy. Across two studies, they found that those scoring high on the Dark Triad are characterized by a distinct psychological profile of personality traits and social strategies. For more on my BPD: http://bahai-library.com/price_mental-health_autobiography_history

B. In their first study, they found that those scoring high on the Dark Triad tended to be moreextraverted, open to experience, and have higher self-esteem. They also tended to be less agreeable, neurotic, and conscientious. According to the researchers, the findings "are consistent with the possibility that the Dark Triad traits reflect a highly selfish social strategy. High level of self-esteem, extraversion, and openness, along with low levels of conscientiousness and anxiety, may be instrumental in enabling an exploiter to persist in the face of potential social rejection and retaliation." In their second study, they assessed self-reported altruism and had participants allocate dollar amounts to themselves and others across a number of scenarios. Based on the allocation patterns, participants were identified as either prosocial, a competitor, or individualist. They found that those high on the Dark Triad tended to be individualistic and competitive. Those high on the Dark triad, however, weren't particularly altruistic or prosocial. This is interesting, because as the authors note, the Dark triad may reflect a self-serving strategy that might not necessarily involve being unaltruistic or prosocial.

The researchers conclude that  "In a world where individuals want to avoid being taken advantage of, those high on the Dark Triad, like James Bond, who tend to be more agentic than others, have a particularly difficult task at hand. How to get what they want without rousing the suspicions or retaliations of others? The answer is to be extraverted, open, high on self-esteem, and low on conscientiousness and anxiety while being individualistic and competitive." So now we know how Bond does it. While I'm not advocating becoming an all-around jerk, perhaps there are lessons both men and women can learn from the Bond psyche (not to mention the cool equipment. As the researchers note, it's possible for people to have multiple social strategies at their disposal, one agentic and measured by the Dark Triad, and oneprososocial, measured with altruistic behavior, agreeableness, and conscientiousness. Flexibility is key here, as there certainly are times when an altruistic, cooperative orientation is essential (e.g., when forming meaningful reciprocal relationships) and times when you may want to adopt an agentic social strategy (e.g., when you want to hold your ground on your beliefs and maintain your self-respect and/or in risky situations that require successfully bouncing back from setbacks).

According to the researchers,

"It is possible that while people are inclined to utilize one strategy versus the other, individuals may have both strategies at their disposal (Hawley, 1999), and the adoption of each strategy depends on the situation and individual trigger points. Such a position has been advocated by those interested in adaptive individual differences (e.g., Buss, 1999) and trait activation theory (e.g., Lievens, Chasteen, Day, & Christensen, 2006)." I do have to hand it to Bond; after I flipped my collar and gave him my most intimidating stare-down, he remained cool as a cucumber. Man he is cool.

------------------------------------------------References------------------------------------------------------

Buss, D.M. (1999). Human nature and individual differences: The evolution of human personality. In L.A. Pervin & O.P. John (Eds.), Handbook of personality: Theory and research (2nd ed.)(pp. 31-56). New York, NY: Guilford.

Hawley, P.H. (1999). The ontogenesis of social dominance: A strategy-based evolutionary perspective. Developmental Review, 19, 97-132.

Jonason, P.K., Li, N.P., & Teicher, E.A. (2010). Who is James Bond?: The Dark Triad as an agentic social style. Individual Differences Research, 8, 111-120.

C. The James Bond series focuses on a fictional British Secret Service agent created in 1953 by writer Ian Fleming, who featured him in twelve novels & two short-story collections. Since Fleming's death in 1964, 8 other authors have written authorised Bond novels or novelizations: Kingsley Amis, Christopher Wood, John Gardner, Raymond Benson, Sebastian Faulks, Jeffery Deaver, William Boyd and Anthony Horowitz. The latest novel is Trigger Mortis by Anthony Horowitz, published in September 2015. Additionally Charlie Higson wrote a series on a young James Bond, and Kate Westbrook wrote three novels based on the diaries of a recurring series character, Moneypenny.

The character has also been adapted for television, radio, comic strip, video games and film. The films are the longest continually running and the third-highest-grossing film series to date, which started in 1962 with Dr. No, starring Sean Connery as Bond. As of 2016, there have been twenty-four films in the Eon Productions series. The most recent Bond film, Spectre (2015), stars Daniel Craig in his fourth portrayal of Bond; he is the sixth actor to play Bond in the Eon series. There have also been two independent productions of Bond films: Casino Royale (a 1967 spoof) and Never Say Never Again (a 1983 remake of an earlier Eon-produced film, Thunderball).

The Bond films are renowned for a number of features, including the musical accompaniment, with the theme songs having received Academy Award nominations on several occasions, and one win. Other important elements which run through most of the films include Bond's cars, his guns, and the gadgets with which he is supplied by Q Branch. The films are also noted for Bond's relationships with various women, who are sometimes referred to as "Bond girls". If you go to this link you will find several prose-poems celebrating 50 years of James Bond films and their relation to bipolar disorder in his life and mine:https://en.wikipedia.org/wiki/James_Bond

RESOURCES AVAILABLE

There are now available a burgeoning range of resources in today’s print and electronic media to help people understand this complex field of mental health.(1)  My life-narrative, a narrative I have called my chaos narrative, is one which I hope will be of help to those who suffer from BPD, from other mental health disorders or, indeed, from traumas of many kinds.  My account is but one small resource for readers and I have posted sections of this account at internet sites which contain a dialogue between people interested in particular mental health issues about which I have had some experience in my life.  My email address is: ronprice9@gmail.com. Any reader who would like to write to me personally in relation to any personal issues raised here feel free to do so.
  This post and my writing on mental health issues is also part of my own effort, my own contribution to the destigmatization of mental illness. Readers need to be warned about what Melissa Raven calls 'killer-statistics' in the mental health field.
----------------------------------------FOOTNOTES-------------------------------------------------------------
(1) Statistics and many statements in relation to mental health are very complex. Suicide is a leading cause of death among teenagers and adults and is a subject unto itself. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide. Mental disorders are frequently present at the time of suicide with estimates from 87% to 98%
. (See: G. Arsenault-Lapierre, C.Kim, G. Tureck, "Psychiatric diagnoses in 3275 suicides: a meta-analysis," BMC, Psychiatry No. 4, p. 37, Nov. 2004)-See "Suicide," Wikipedia.
(2) Melissa Raven, 'Beware of “killer statistics” in the mental health field,' The Crikey Health Blog, March 18, 2011. Melissa Raven is a psychiatric epidemiologist and policy analyst, Adjunct Lecturer, Discipline of Public Health, Flinders University and a member of Healthy Skepticism.

ANALYSE THIS: WHEN A PSYCHOSIS IS FUNNY
...and when mental illness is stigmatized

Part 1:

Analyze This is a 1999 gangster comedy film directed by Harold Ramis. He co-wrote the screenplay with playwright Kenneth Lonergan and Peter Tolan. The film starred Robert De Niro as a mafioso and Billy Crystal as his psychiatrist. A sequel, Analyze That, was released in 2002. I had the pleasure of watching these two comedy films about a mafia mobster who has a psychotic-break while in prison and several panic attacks outside prison. It was more than a dozen years, though, after these films were released before I watched them. That is the pattern now in the evening of my life. I have not been to the cinema in all the years of my retirement from paid-employment since back in 1999 when I lived in Western Australia. I wait, and eventually I can watch the movie on television.

Initially there was no plan to create a sequel to Analyze This, but the positive reaction generated by the first film encouraged the producers to consider a sequel and discuss it with the studio and actors.  They believed, as Crystal put it, that: "There was an unfinished relationship between Ben Sobel and Paul Vitti, the psychiatrist and the mobster,  from the first film" and "there was a good story to tell", so the sequel was commissioned.  I leave it to readers with the interest to Google the story, the plot and the characters, the production and background details, the box office and reception/ratings the films received, the money which the films grossed, and all the who's whos.

Part 2:

In the last 50 years, since the first manifestations of bipolar disorder in my late teens, I have been stabilized on anti-depressants and anti-psychotics.  In those same five decades, there have been an increasing number of films and TV series that deal with issues of mental health. I won't even try to summarize them all. They each deal, in their own ways, with specific disorders and, from time to time,  with Sigmund Freud, Carl Jung and the infancy and development of the psychoanalytic movement.  

"Freud has never been more relevant," said David Cronenberg(1943- ) recently. Cronenberg is a Canadian filmmaker, screenwriter, and actor. He is one of the principal originators of what is commonly known as the body horror or venereal horror genre. "Because of Freud's understanding of what human beings are, and his insistence on the reality of the human body. We do not escape from that. Jung went into a kind of Aryan mysticism, whereas Freud was insisting on humans as we really are, not as we might want to be."2

Cronenberg points out in relation to some of his more extreme depictions of violence and sex, mental health issues and criminality that: "Different countries have different reactions to my depictions of somewhat extreme situations and topics..2   Some films are successful in some places; some not. What will play in Glasgow for three years non-stop will be taken off the air in a dozen or more Middle Eastern countries.......I'm interested in people who don't accept the official version of reality, but try to find out what's really going on under the hood."-Ron Price with thanks to 1Wikipedia, 7/2/'15; &  2Steve Rose, "David Cronenberg: Analyse this," The Guardian, 6 February 2012.

Part 3:

The psychotherapy used in these
movies, like that used in the TV
show, The Sopranos, raised all
sorts of questions about human
nature & morality; for example,
can a criminal mind be changed,
and committed to going straight?
 
What is the nature of a psychotic
break and can it be treated in the
short-term without medications &
therapy for years to come?.....Are
these portrayals of mental health
problems honest and accurate???
Ron Price 7/2/'15 to 9/2/'15.

Mr JONES and ME

Part 1:

I saw the 1993 movie Mr Jones at some time during the years when I was retiring from FT, PT and volunteer-work, 1999 to 2005, and retiring from an extensive involvement in Baha’i community life.1  I had had a working life of 50 years, 1949 to 1999,  and been involved in the earliest years-decades of community-building for Baha’is in Canada and Australia.  

I don’t remember now exactly when I first saw Mr Jones, but I watched the last half of that same movie last night.2   In the movie Jones was diagnosed with manic-depressive illness in his late adolescence. He had several hospitalizations over more than 20 years.  I, too, was diagnosed with a variant of manic-depressive illness. It was called a "schizo-affective state" at first, but a dozen years later psychiatrists  gave it the name bipolar disorder.  Jones talked about his serious suicide attempt at college; I have had suicidal ideation or the death-wish, as it is also and sometimes called, for more than half a century from 1963 to 2015.

Part 2:

Watching this movie made me reflect on my own experience and the result is this prose-poem.-Ron Price with thanks to 1 The Universal House of Justice, April 1996; and 2Mr Jones, 7TWO TV, 10:40-1:00 a.m., 23 & 24 March 2012.

Richard Gere is a lovely fellow;
Lena Olin is even more lovely.1
But bipolar disorder is not-so-
lovely & needs to be watched
all of one’s life. After Gere &
Olin form the bond that ends
the two hour movie I wonder
what happened to him in his
middle age, late adulthood &
old age…Did he come to full
compliance on his meds;  did
he have more talk therapy or
did his battle continue with a
win-win as one likes to think.
1these were the leading actors in this film

Ron Price
24/3/'12 to 9/2/'15.

SOME REFLECTIONS ON MENTAL HEALTH ISSUES IN THE MOVIES

Part 1:

If I were a Hollywood actor in the last fifty years (1965-2015), to say nothing of films in the last seventy(1945-2015) years of my life, I would be calling my agent to be on the lookout for roles in which I could play a mentally troubled character. Just about every possible disorder finds its place in at least several, if not one or two dozen, films in the decades since WW2.

If I listed all the films, not to mention the TV series containing mental disorders, which I've seen in those 70 years, this prose-poem would go on far too long. I will, though, list some of the disorders themselves: antisocial, avoidant and borderline personality disorders; histrionic, narcissistic, and obsessive-compulsive personality disorders; schizoid and schizoaffective personality disorders, inter alia. The list is legion, and the disorders I have mentioned are just a start.

Part 1.1:

I will list a few films I've seen since retiring from FT, PT and casual-work and enjoyed while on an old-age pension in the last decade: 2006 to 2015. Dustin Hoffman in the 1988 film Rain Man won an Academy Award for 'Best Actor in a Leading Role' for his portrayal of a man with autism; Kathy Bates earned her Oscar playing a woman with delusional disorder in Misery in 1990; the next year, Anthony Hopkins earned one for the role of a cannibal/serial killer, in the 2001 film Hannibal;  in 1993 Holly Hunter was the mute heroine in the 1993 film, The Piano; 1994 produced Tom Hanks as the PTSD and mentally challenged but winning Forrest Gump; in 1995 there was the alcoholic-clinically depressed Nicholas Cage of Leaving Las Vegas; Geoffrey Rush won the Best Actor award in Shine for his 1996 performance as the schizoaffective pianist David Helfgott; 1997 was Jack Nicholson's turn in As Good As It Gets for doing obsessive compulsive disorder; James Coburn picked up his Oscar as the sadistic paranoid father in 1997's Affliction; and in 1999, Michael Caine was a narcotics addict and Angelina Jolie co-starred as a person with clinical depression or a sociopath of Girl, Interrupted. All of the following films featured BPD: Mr. Jones (1993), Pollock (2001), Sylvia (2003), Mad Love (1995),  and Michael Clayton(2007).

Part 2:

Overall, the mass media do a poor job of depicting mental illness, with misinformation frequently communicated, unfavourable stereotypes of people with mental illnesses predominating, and psychiatric terms used in inaccurate and often offensive ways. People’s information and knowledge of mental health subjects comes, for the most part, from television.  TV often perpetuates the stigma and the negative stereotypes by inaccurate depictions, misinformation and uninformed dramatic sketches. This has been part of the world of the mentally ill for centuries and it has been part of the backdrop of my own experience in these several epochs.

In some ways it is difficult to appreciate how far society has come in its knowledge and understanding; in other ways the problems are massive and complex. The list of activities performed by people and various organizations dedicated to struggle against stigma, though, is not only impressively long and wide-ranging, but provokes strong inspiration as well.

The year 1981, for example, was proclaimed the International Year of Disabled Persons (IYDP) by the United Nations.  It called for a plan of action with an emphasis on equalization of opportunities, rehabilitation and prevention of disabilities. The theme of IYDP was "full participation and equality", defined as the right of persons with disabilities to take part fully in the life and development of their societies, enjoy living conditions equal to those of other citizens, and have an equal share in improved conditions resulting from socio-economic development.  By 2008 there were 3,900 athletes from 146 countries in Beijing at the paralympics. Although this extended discussion of the disabled portrayed in films and the disabled in sport is tangential to my BPD story, it is relevant to mention, en passant.

Part 3:

The illness I had suffered from, starting perhaps at my conception in 1943, had become, in some ways, a source of claim to fame. But it was not all a story of a new age of understanding. On television, that most popular story-teller in modern society, people negotiated their attitudes to and their understandings of different social and political issues of which mental illness/distress was but one. The most common disability portrayed on television during the years that my autobiography was being written, 1984-2015, has been mental illness/distress.


MENTAL HEALTH AND LANGUAGE

Part 1:

The following blog at the Healthy Place internet site deals with the problem of language with respect to mental health issues. The writer at this blog likes the word 'crazy'  to describe her life with BPD. She uses the word in her daily life in her interactions with others. But the word, 'crazy' like the terms 'mentally ill' or even 'mental health' problems or issues, all have their downside.  In some ways, one of the main problems for Everyman, that is raised for the entire subject of illness, to say nothing of mental illness. is one of language. There is a world of language associated with attempts to describe not only the physiology, the biology, the medical side of BPD, in addition to one's experience with BPD over the short term or over a lifetime.

A large part of the problem, then, in talking about health is the use of complex language. The field of mental health is replete with complex terminology.  It is helpful for those with various types of mental health problems to become as familiar as they can with this language. I try for the most part to use simple language—but I do not always achieve this aim.

Part 2:

Language is a problem not only with respect to health issues, but also with respect to many other complex issues and subjects in society.  KISS, keep-it-simple-stupid, an acronym I used for many years as a teacher of  English, does not solve all the problems with writing and language, as well as with communicating to others about complex subjects. Readers who object to the word "stupid", as one reader did object several years ago, might prefer the word "silly". Whom the gods would destroy they first make simple and then simpler and then simplest, to alter slightly an aphorism by Anonymous, an ancient proverb wrongly attributed to Euripides(480-406 BC),one of the three great tragedians of classical Athens, the other two being Aeschylus and Sophocles
.  I will leave this problem, this spectrum of complexity and simplicity here. All being well, I will return to it another time. This problem of language will not be going away at this website or in the lives of the billions of the world's peoples, at least in the short term.

Readers can go to the following three links below to follow-up on these introductory paragraphs:

http://www.cinematherapy.com/birgitarticles/Mr.-Jones.html

http://www.medhelp.org/user_journals/list

http://www.healthyplace.com/blogs/breakingbipolar

MY STORY MY CHAOS NARRATIVE

A Personal-Clinical Study of A Chaos Narrative, by Ron Price

Some of my internet posts below on the subject of bipolar disorder: mine and others:

http://www.depressionforums.org/forums/topic/66962-amy-winehouse-rip/

http://www.mentalhealthforum.net/forum/showthread-Bipolar-Disorder-and-PTSD

http://www.medhelp.org/user_journals/show/73586/My-BPD-Story-Instalment-1


MENTAL ILLNESS: AND FAMILY HISTORY

Did your parents ever have "the talk" with you? Have you had "the big talk" with your children? No, I don’t mean the "s_x talk." I’m talking about discussing your family’s history of mental illness. Shawn Maxam, author of "The Bipolar Griot" blog on HealthyPlace, shares his recent conversation with relatives about mental illness in his family. He says it left him feeling empowered knowing he wasn't the only family member with a mental illness. Mental illness affects around 20% of Australians every year, but it is treatable. There are many commonly-asked questions about the effects of mental illness on the families of people affected, and how they can be supported to help the person and themselves. The term ‘family’ is used to describe any relative or friend who cares about the person with a diagnosis. For more go to:http://www.sane.org/information/factsheets-podcasts/206-families

FAMOUS PEOPLE WITH BPD AND THEIR FAMILIES

Virginia Woolf(1882-1941) was an English author, essayist, publisher, and writer of short stories. She is regarded as one of the foremost modernist literary figures of the twentieth century. In recent years she has acquired a totally new place in literature. Her fame has always rested on her novels and partly on her essays, which, though they resemble the feathers in a boa beside the achievements of modern literary criticism, can still delight those who have an ear and an eye as well as a mind. She has always been a phenomenon, an event which anyone who regards the novel as a great art form cannot ignore whether or not he dismisses her claim to be as important as she desperately hoped to be. For more on this subject go to: http://www.nybooks.com/articles/archives/1978/apr/20/virginia-woolf-fever/?pagination=false


It is natural, and no doubt correct, to suppose that Leonard Woolf, her husband, has been thought to deserve an elaborate and large-scale biography because he married Virginia Stephen. But one needs to be careful how one phrases that remark. For the infinitely poignant story of Virginia Woolf’s life and death would certainly have been different if there had been no Leonard Woolf; his behavior in the marriage was remarkable and is the most impressive thing about him. For more on this subject, on this biography of Leonard Woolf go to:http://www.nybooks.com/articles/archives/2006/dec/21/the-love-of-a-pessimist/

MENTAL ILLNESS: PEOPLE I HAVE KNOWN

Part 1:

Over a lifetime of traveling and settling for varying lengths of time in cities, towns and in places of work as well as being a part of different communities,  I have run across a number of Baha’is who suffered from a history of mental illness in one form or another. I have met them beginning as far back as the spring of 1963 when I was suffering from hypomania, a mild form of mania, and a not-so-mild depression in the fall of that same year.  I continued to meet them in the various towns I travelled through and lived and taught in as a pioneer in both Canada and Australia.  I met many more in the 1980s and 1990s in Perth, refugees from Iran and by then Australians whom I got to know in the Baha'i communities I was a part of in Perth Western Australia.  Just this last weekend, an Australian here in Tasmania, told me of his long history of mental illness. I have also met many people who were not Baha'is who suffered from a range of disorders in the mental health domain. When one suffers oneself others are more inclined to open-up. But this is not always the case, many people I know hesitate to form a relationship with me due to my mental illness.-Ron Price, Pioneering Over Five Epochs, 2011

Part 2:

Dr. V. Payman, a Melbourne psychiatrist and also a Baha'i, told me about the negative affects on mental health of the Iranian refugee experience.  This Iranian diaspora, throughout the twentieth century, but increasing dramatically after the revolution in Iran in 1979, resulted from the persecution of Baha'is in that country. It is a persecution that is now nearly two centuries old. Many of Dr. Payman's clients were first and second generation Baha'is in Australia who had come from Iran to escape the many forms of prejudice, ill-treatment and social venom.  In addition to the Baha'is I have known there have been a host of others on the internet at dozens of sites with whom I entered into discussions on the subject of mental health in the last decade.

The world of mental illness
was transformed in those
four decades, but still there
were the sufferers whom I
met from place to place with:
their acute senitivities, their
talents and abilities, their
capacity to talk & especially
understand life’s complexities.

A writer, a pianist, a holder
of sixty part-time jobs in his
life. Good-grief Charlie Brown,
could  some of them talk & talk,
all on the periphery but still
accepted in the centre when
they could handle the music.(1)

The Cause attracted all kinds
of the mentally ill, a loosely
defined group, who were found
far-&-wide in our global society,
and they began to proliferate
the commentariat and often in
disguise: no one knew nor did
they themselves that below the
surface were unsolved problems
that were just too complex to
deal with as society's tempest
blew-blew to the furthest parts
of the planet harrowing-up the
souls of billions and millions!!

Ron Price
1 February 2000 to 3 December 2011

(1) The terms ‘centre’ and ‘periphery’ are used in the social sciences for several purposes.  They were once apt terms to describe those who were active and those who were inactive in the Baha’i community.  In the new Baha'i paradigm, 1996 to 2011, the terms/labels active and inactive, deepened/veteran and undeepened/novice, meeting-goers and non-meeting goers, inter alia, were gradually falling into disuse. The international Baha'i community was recognizing formally what it had already recognized informally for decades; namely, that the Baha'i community was a heterogenous mix for the most diverse types, some of whom had become members of this global enterprize and some of whom associated with Baha'is since they shared common interests and/or developed friendships with Baha'is. The Baha'is have been attempting to create community, especially in the last two decades, a unity in diversity, and it was no easy task.

WRITING ABOUT MENTAL ILLNESS

Alan Bennett(1934- ) is an English playwright, screenwriter, actor and author. He attended Oxford University where he studied history. He gave up academia, and turned to writing full-time; his first stage play Forty Years On was produced in 1968.  In his 2005 prose collection Untold Stories, Bennett wrote candidly and movingly about the mental illness that his mother and other family members suffered. His stage play The Lady in the Van includes two characters named Alan Bennett.  Somewhere in his published diaries, Bennett observes that when misfortune befalls a writer the effect of it is in a small but significant measure ameliorated by the fact that the experience, no matter how dire, can be turned into material, into something to write about.

This became true for me by my late 50s, after I took an early retirement, a sea-change as it is called in some places, and reinvented myself as a writer and author, poet and publisher, editor and researcher, online blogger and journalist, scholar and reader. I am now nearly 70 and have written a great deal about life's misfortunes and, especially, my mental health issues.

WHO KNOWS YOU?

Part 1:

American educator John Bradshaw once said something to the effect that "no one else can ever really know us." John Elliot Bradshaw (1933-) is also a counselor, motivational speaker and author who has hosted a number of public broadcasting service(PBS) programs on topics such as: addiction, recovery, codependency and spirituality. Bradshaw is active in the self-help movement, and is credited with popularizing such ideas as the "wounded inner child.” His books are mainly works of popular psychology.  In his promotional materials, in interviews and in reviews of his work, he is often referred to as a theologian.

"I swear by Him Who hath caused Me to reveal whatever hath pleased Him! Ye are better known to the inmates of the Kingdom on high than ye are known to your own selves. Think ye these words to be vain and empty? Would that ye had the power to perceive the things your Lord  the All-Merciful doth see, things that attest the excellence of your rank, that bear witness to the greatness of your worth, that proclaim the sublimity of your station!"(1)

The inmates of the Kingdom love you. To me that is more tangible than saying that "God" loves me. God is an abstract; the inmates of heaven are real people, who lived, struggled and died, and know how hard life can be. They watch over us. They perceive the difference between us and our illnesses better than any living human can. 
As for normal humans, they are, well....human. It is human to want to protect oneself from the damage that others might inflict upon us. That you are currently in a good space is wonderful. You know it. God knows it. You can tell the world that you are not going to be abusive or hurtful demanding or critical, but it is difficult for people who are NOT you to trust that because you are not perfect and both flesh and spirit ere.

Part 2:

Love is not an on/off switch. It is not either there or not there. Love is an attraction to the attributes of God reflected in the world of creation-in the world of the human soul. People can be attracted to 50 of your wonderful qualities and long to bask in their spiritual radiance, but at the same time be afraid to subject themselves to the one, or the five or the fifty destructive qualities that have hurt them in the past. Understanding and acknowledging this dilemma, rather than being hurt or disappointed by it, might help create the space you and your family need to take tentative steps towards each other again.

Let them know that having contact with you does not mean that they have to forgive everything you've done, or that they are committing to stay in your life if you start exhibiting destructive behaviors again. Offer a trial relationship, put yourself on probation, go 1-day-at-a-time and see if people are more open to contact with you.(2)--Ron Price with thanks to: (1)
 Gleanings from the Writings of Baha'u'llah, p. 316, and (2) Justice St. Rain, "Baha’i Mental Health Yahoo Group," 3 June 2010.

A test as an opportunity to take responsibility for my own life. Instead of asking God to solve my difficulty, I ask God to show me the tools of character I need to solve it myself....God is still solving the problem, because it is the attributes of God within me that are creating the solution, but instead of being a passive recipient of God’s grace, I am an active participant in the solution. 
Let go of guilt, shame, fear and depression. They do absolutely no good. Don’t just pray for God to solve your problems. Pray that God shows you how to be an active worker and participant in the solution to your problems!!

OUT OF THE CLOSET

Pierre Trudeau was the Prime Minister of Canada when I travelled as a pioneer to Australia in 1971 for the Canadian Baha’i community. By July 1971 I was teaching primary school in South Australia. In March 1971, three months before I left Canada, Trudeau married Margaret Sinclair, a beautiful 18 year old flower child of the counter-culture from the sixties. She was 30 years younger than he. Four years ago, in 2006, Margaret Trudeau went public about her lifelong struggle with bipolar disorder(BPD). This year, in 2010, her story of that battle is in a book entitled: Changing My Mind1. –Ron Price with thanks to (1) Andrew Cohen, “What A long, strange trip it’s been,” The Globe and Mail, 22 October 2010.

Thanks, Margaret, for the story
of your tortuous journey, your
account of the extreme moods,
emotions which silently shaped
your life right back to childhood
in this your third memoir….BPD
made for an inconstancy in your
decades of living….that medical
affliction slowly getting socially
destigmatized at last..I started to
go public about the same time as
you did, Margaret, on the WWW
and you can find me at more than
100 internet sites which deal with
depression, affective disorders, &
BPD in mental health’s vast world.

Celebrities, like you, who go public
help folks like me…...the ordinarily
ordinary man who has also battled
through emotional turmoil’s road!!

Ron Price
25 November 2010