Letter to the Psychiatric Times editor: Mania and Hypomania: The Latest Thinking on Duration of Episodes and Other Features

Dear editor,

In response to the October 29, 2019, article by Dr. David Osser, I would like to share insight into diagnostic modeling from the patient perspective.

https://www.psychiatrictimes.com/article/mania-and-hypomania-latest-thinking-duration-episodes-and-other-features

I’ve got bipolar. Both I and II. And schizoaffective disorder. And . . . anything else diagnosed in that 15 minute span of presentation at the ER, which is where I received each of these diagnoses.

For me, an initial diagnosis is a great place to start deciding how to treat my symptoms. After that, the game plan is to treat my specific symptoms and not the diagnosis. Providers sometimes miss this essential progression in treating peers because of adherence to diagnostic criteria.

My significant issue with bickering about manic durations is that showing symptoms for too short a span (it appears 7 days for mania and 4 days for hypomania) serves the primary medical rationale “We might treat it wrong if we don’t have the proper diagnostic definition.”

I’ve been riding this rodeo since 1987, diagnosed in 1999. I’ve had rapid cycling with frequencies every hour and not days. Some providers question the existence of mixed episodes. I’ve had a provider insist I treat psychosis first because of the schizoaffective diagnosis, when the psychosis is consequential of severe depression. Treat the depression, the psychosis goes away.

In all this time messing about with treatment, there is one constant:


All mental health treatment is trial and error.


So, does it really matter about the duration of mania in treatment? I’m showing mania-oid symptoms that happen to last three days. Try me out on some LiCO3. If my mania-oid symptons abate, bam, good job. It’s mania. If not, then . . . let’s trial and error other treatment options.

Being practically cynical, adhering to a minimum episodic duration means peers like me won’t receive the proper treatment of mania because I don’t meet the diagnostic criteria. This is exactly the contrary argument being debated for a revised two day episodic duration . . . even with the proposed revision, my true treatment needs again fall outside the diagnostic capture zone.

Being fully cynical, I often believe the DSM is a billing manual more than a diagnostic treatment manual. This is borne primarily from years of trial and error treatment efficacy frustrations and probably isn’t a reflection of actual purpose.

All said, my sincere recommendation for providers is treat the person and the empirical symptoms and not the diagnosis and diagnostic criteria. This is what works best for me in my recovery journey.

Kindest regards

Steve Bringe
Founder, Stand Up To Stigma

Dragging Me Kicking and Screaming.

My divorce . . . I wasn’t fond of my divorce. The only difference between my divorce and a bloody, puss-filled, and inflamed hemorrhoidal tissue is nothing. It was icky and messy, it hurt really really really bad, and it was a world-class pain in my arsecrack. So uncomfortable, so ouchy.

After my divorce, I did that most natural of bipolar activities. I isolated. Big time. Calls went unanswered and window shades unopened. The thought of retrieving mail brought on such anxiety-ridden bouts of sleeplessness and self-doubt I questioned my ability or willingness to breathe. My Blanket Fortress was in a perpetual threatened state of being saturated in urine because, in practical terms, it would be easier to change my sheets later than to take on the Himalayan expedition of crawling to the bathroom to use the toilet. I kid you not. This was a serious debate I had each day. My divorce left me in razor-thin mortal existence and my bipolar depressive symptoms were insistent on knocking me off this ragged edge.

I have friends. And, with some of these friends, I was missed. This longing for my presence elicited concern and this longing also elicited an unsolicited visit to my home. I have friends, and I have very good friends who know about my bipolar symptoms and I have very good friends who like me alive. One such friend is Michael.

After a month of completely ignoring the world, Michael and his boyfriend came to my home and kept unrelentedly ringing the doorbell, and despite my bipolar depression sensibilities, I had to answer the door just so I could murder whoever was incessantly leaning on the doorbell button. No, I don’t want another copy of The Watchtower. I appreciate you dropping by. Oh, yes. Stand very still. You have to be murdered.

Drats. It was Michael at the door with Geoffrey. They were smiling, although Geoffrey appeared nauseous over my appearance and aroma. Yes, I was nasty gross from weeks of hygienic neglect. Still, don’t invest too much weight in Geoffrey’s reaction because a used bandaid floating in a public pool triggers Geoffrey’s gag reflex so badly that he dry heaves until his entire body is turned inside-out.

Michael said, “Get ready. You’re going out with us tonight.”

I said, “Michael, leave me alone. I feel like shit.”

Michael said, “No choice, buddy. Get in the shower.”

I said, “Michael, I don’t have the energy for a shower. Just go away.”

Michael said, “Fine. We’ll give you a bath.”

I said, “Michael, I’ve told you a trillion times, I’m not gay and regardless of sexual preference I’m not into threesomes.”

Michael said, “You can’t insult me until I go away. Off to the bath.”

I said, “Fine.”

Geoffrey said, “Uggggg!!! I just threw up a little bit in the back of my throat!”

I said, “You had to wait to say that until my clothes were off? What an excellent ego boost you offer.”

Michael said, “Grow up. And don’t bother deciding on your outfit for the night. We have something special set for you.”

For Michael and Geoffrey, the outfit was more important than hygiene, but only just. What they had planned for me involved many razors and many parts of my body. It involved the makeup aisle at Walmart. It involved a trip to Savers. It involved viewing clothing sized “14” rather than sized “L.”


I was being dolled up in drag and taken on the town.


Shit. I hate my friends.

After the rigorous scrubbing so I didn’t smell like a dumpster fire in the alley behind a curry house, I had so little energy to argue or struggle. I just said, “Shit, Michael. Fine. Whatever. I have only one demand or I’m not going.”

“And what’s that?” inquired Michael, already boasting a smile that wouldn’t fade.


“I’m only going if you promise to keep anyone from hitting on me tonight. I’m severely depressed. I can’t take that kind of attention from anyone.”


With no hesitation, Michael and Geoffrey agreed to my non-negotiable. Perhaps demanding EVERYONE hit on me would have made them go away.

Painted up with cheap, vibrant face makeup so I looked like a Teletubby vomited a bag of Skittles on my head, and spruced up in a Prince-purple discoball sequined full length prom dress and electric-shock blonde wig, Michael and Geoffrey shared we were going to dinner at my favorite restaurant at the time (Trombino’s on Academy, still a fave) and then off we’d go to shake the night away at Pulse (admittedly, the best dance club with the best dance music in Q-Town). I barely picked at my thick and rich chicken/pasta plate. I barely had the energy to lift my chin above 24 degrees off my chest. How the hell was I supposed to go dancing to a bass-soaked 350 bpm reimaging of INXS’s “Need You To Night”? Collapse was imminent. I didn’t drive myself, effectively without escape. I was screwed.

“I’m not kidding, Michael. Nobody better hit on me tonight. Get the word around as soon as we get to Pulse.” My mood sucked and I was exhausted from bipolar depression increasing the gravitational constant of the universe for only me. I had nothing left in me to ward off unwanted romantic attention. It’d be easier to melt into a puddle of infected off-green sinus-goo and take residence in a CDC petri dish for all eternity. Michael sighed his reply.


“I heard you and we agreed to protect your chastity. Don’t worry.”


We got to Pulse and I wearily pleaded with Michael and Geoffrey to crack the window and leave me in the car. No go. Michael is slim and Geoffrey is short. How they hauled my 6’3″ nearly-dead weight frame into the club and kept me upright on the dance floor for three hours is Herculean and I learned that night that either bloke could kick my ass if wanted, even when I am at full strength. Very humbling, although it did make me feel very safe and protected. This was important.

The three hours were the worst three hours I’ve ever spent immediately following a meal at Trombino’s while dressed up like a prom date drunk on steroids. It couldn’t end soon enough and it didn’t. The saving grace is Michael and Geoffrey were true to my demand and I wasn’t hit on all night.

Finally, my upright misery could turn into prone misery as Michael and Geoffrey ferried me back to my house and the safety of my Blanket Fortress. It was the first time I was out of the house in over three weeks, and truth told I didn’t hate being out of the house. This is entirely credited to the love and caring Michael and Geoffrey showed me. This sort of adoration is energizing I’ve come to appreciate in my very best friends.

Collapsed in the back seat of their Prius, I forcibly mumbled out, “Hey, guys. Thanks for getting me out of the house. And really thanks for honoring my wish. No one hit on me all night and that means everything. Thank you.”

Michael looked at Geoffrey and Geoffrey looked at Michael as if thumb wrestling to decide who would acknowledge my gratitude. It was Michael who lost.


“Um, Steve. We didn’t have anything to do with that. You just make a really ugly woman.”


After leveling that devastating full-body ego slam, my friends stayed the night to make sure I didn’t kill myself.

It was one of the best nights of my life.

Kindly reprinted from Steve’s Thoughtcrimes.

I’m Human, You’re Human, Let’s Talk

I’m Human, You’re Human, Let’s Talk.

by Amanda Jenson
STS Editor

We’ve experienced another several horrific tragedies lately. As someone who knows what trauma and pain feels like I am sorry. I see you. I hear you—even if I can’t know exactly how you feel. I won’t pretend to.

When these tragedies strike the media focuses on the gunmens’ mental health. I don’t deny that someone who creates such heinous misery has some kind of insanity clouding the mind, but we focus so much on his or her mental health that we forget to focus on the survivors’ mental health and what they are now going through.

My friend with bipolar pointed out that the victims still living will not want to seek care for their health now because the media (including president Trump) immediately bludgeons our feeds with the stigma that having a mental health issue means you are violent.

Proof:

“This is also a mental illness problem,” Trump said of the mass shootings. “These are people that are very, very seriously mentally ill.”

“Trump called for reforming “mental health laws to better identify mentally disturbed individuals who may commit acts of violence and make sure those people, not only get treatment, but when necessary, involuntary confinement.”

“Mental illness and hatred pulls the trigger, not the gun,” Mr. Trump said. Calling mass shooters “mentally ill monsters.”

Unstable gunmen are dangerous, no doubt, and there are no words for the horror I feel at the actions committed by these people, mental illness or no, but comments like these are dangerous for thousands, if not millions of those who suffer with mental illness. We are now “monsters” who don’t belong in public. I’m appalled at the ignorance and stigma portrayed and a little awed at the uncaring and unfeeling behavior they display to those who suffer with mental illness.

Those emotions sound a little like how they describe the gunmen.

Victims may see their symptoms of deteriorating mental health and equate themselves to being dangerous as well, just like their persecutor was.

Who would want to get mental health care if “involuntary confinement” is being used as a means to control those who may want mental illness help? Chills curled their gentle governmentally-controlling fingers down my spine when I read this.

If the media wants to discuss and accuse mental health as the problem for these violent acts then look at the full spectrum of how mental health plays into tragedies, because we now have many people out there ruminating on a bloody scene that they can’t quite believe was real, trembling in the night instead of sleeping. People are flinching and crying in a corner, trying to cover their ears and heads simultaneously, from every little sound they hear. They are wondering if the generally safe world they once knew was a lie. They won’t let their children leave the house now. Their anxiety has overtaken their body and they aren’t eating. They’re vomiting every time they try, their tears rushing too quickly down their face. They aren’t even sure if they are alive anymore. Did they die in the shooting? They think they should’ve died instead. They wouldn’t experience this horror and guilt that they are still living. Those gunshots they keep hearing? Are they inside or outside of their head? They just want those images gone. Some can’t stop picturing their loved ones lying broken on the ground.

And then you have the other spectrum. You have the people laughing, saying they’re fine—the people who perhaps even make crass and sadistic jokes. Why? Are these people sociopaths? They feel numb. They are thinking, “What’s wrong with me?” and instead of seeking help, close themselves off even further for fear of being dangerous and out of guilt of their seemingly callous reaction. Are they like the gunmen? No. A resounding no!

They are dissociated from horrors that can break the human mind. It’s a natural response to disasters and serves a survival purpose. I would know. I have a dissociative disorder borne of extreme violence and horror in my childhood. My disorder is considered a “severe mental illness”. I still function as a kind member of society. (Yet I know what it’s like to sit in that corner shaking and crying due to PTSD. I also know what it’s like to pop out inappropriate jokes.)

Do I want to go shoot people? Never.
I’m seeking professional and community support for my trauma and pain. I hope those affected by these tragedies will too. I hope they look past the media and governmental stigmas and get the support, love, and understanding they deserve and is naturally needed. There are many of us out here in the community with mental illnesses waiting to hug you, waiting to tell you what services and help you can get, waiting to express how sorry we are and that we know—not exactly, not perfectly, but we know.

I know what it feels like to be cruelly victimized by people. I know what trauma and horror is. It’s stuck in my brain too. Most people with mental illnesses are loving, intelligent people who advocate for others who struggle with mental health issues. Let us hold you now.

Hey White House, Media and those with stigmas still, don’t you think some of these people affected by this will be suicidal? Do you think the horror is over for them just because you played the blame game so effectively? Want to save some more lives? Stop insinuating that all mental illness is dangerous and that those of us with them need to be locked up against our will.

Those affected will be suicidal. Some are now. Save the people left too, stop just focusing on the horrors already committed. And for the love of all humanity (literally), stop telling the world that those of us with mental illnesses are all dangerous. Save the ones who won’t get help now because of your dangerous and scape-goat comments. Stop perpetuating the violence you claim you want to fix.

1. https://www.cnbc.com/2019/08/04/trump-says-hate-has-no-place-in-our-country-after-shootings-in-dayton-and-el-paso.html

2. https://www.thedailybeast.com/trump-calls-for-involuntary-confinement-of-mentally-ill-in-shooting-address

3. https://www.nytimes.com/2019/08/05/us/politics/trump-speech-mass-shootings-dayton-el-paso.html

4. https://www.cnbc.com/2019/08/04/trump-says-hate-has-no-place-in-our-country-after-shootings-in-dayton-and-el-paso.html

My Seasonal Affective Disorder is a Real Drag this Time of Year

Something needs to be done about my Seasonal Affective Disorder and how insufferably cheerful and gratingly pleasant I get during summertime. Not imposing upon my loved ones just because I’m joyful must be leaving a huge void in their heart. There must be a med to drag me into even a mild doldrum, requiring the people in my life the burden of having to be on suicide watch 24/7.

I hardly want to spend any time at all in my bed beneath my Blanket Fortress. And this unforced smile is so easy and uplifting. What a chore this is. For myself, for everone.

I’m so sorry for feeling happy and productive once again. I feel selfish to the core.

Forgive me for this and I’ll forgive you for eating the whole goddam bag of Cheetos. Those were for everyone, you realize.

Reprinted with kind permission of Steve’s Thoughtcrimes.

Accomplishment is Measured in Effort

Having been attending STS support groups (formerly DBSA Albuquerque) since October 14, 2010, I’ve heard said, “All I could do today was take a shower. I was exhausted. I feel like such a failure.”

I’ve heard similar words out of my own mouth, although mine was more akin to “All I could do today was make it halfway to the toilet from my bed, decided I wouldn’t have the strength to lift the toilet seat if traversing the entire remaining distance, so I moistened the carpeted floor over which I stood, and then my knees buckled from the exertion of urinating, never making it back to bed, and lightly moistened myself. Big win!”

Thing is, that was all the strength I had that day. Every. Last. Ounce. Of. Strength. Getting halfway to the bathroom took all the effort I had that day.

Contrast that with a few months on, and I’m training for a marathon. Truly. And that was the strength I had that day. Every. Last. Ounce. Of. Strength. Training for a marathon took all the effort I had that day.

Let’s say it together.


There’s a HUGE difference betwixt peeing on the floor (and collapsing into said puddle of pee) and training for a marathon.


And let’s have me counter immediately this fallacy.


Nothing a peer accomplishes is a “pathetic small thing” and a “monumental huge thing.”


Why, that makes no sense, says some. How can I make such a claim?

This is because, as a peer, I measure my accomplishments in terms of “effort.” If all the effort I have gets me halfway to the bathroom from the bed, it is EXACTLY equivalent of all the effort I have to train for a marathon. It’s the magnitude of the effort, not a qualitative “that is so much more than this” stigma.

Where I’m going to with this is to say to my fellow peers, pat yourself on the back, on the front, on the arse, wherever, because any accomplishment that expends all your effort for the day is HUGE!


HUGE!!!


I don’t beat myself up any longer, with “Geesh, I’m pathetic and weak. Why am I so exhausted?” I’m exhausted because I put every last bit of effort I have in me into whatever supposedly pathetic, weak task I accomplished. Some days, it’s making it to the toilet and back into bed. Some days, it’s pushing hard so I can beat a three hour finish time on the marathon.

Give yourself credit, peers. You didn’t ask for this life, with a brain condition that determines how your effort can be expended that day. Give yourself credit because you accomplished something amazing.

Self-disclosure. Before losing Clare, I felt I had unlimited reserves of effort. Nowadays, just making it to STS support group takes everything I have not to stay home and isolate instead.

Measure your deeds in the amount of effort you put into it. It’s that magnitude of effort that defines your accomplishment. Such as, reading through this entire article wondering if my meds are working properly. I know how much effort this takes. I’ve been told so very many times.

For Mental Health Peers, “In the Closet,” “Coming Out,” and “Outing Myself” are naughty, icky, and meanie words

Stigmatization is a cruddy reality for those contending with the symptoms of illnesses, mental and medical alike. There’s a group of terms affiliated with stigmas I really don’t like in the least, the most, and all points betwixt:


“In The Closet,” “Coming Out,” and “Outing Myself.”


I’d like you to look at this photo of the NAMI Challenger. The front page article is one I composed during my time on the NAMI Albuquerque board. I ask you to look at this photo and remember it because when we travel full-circle back to “in the closet, “coming out,” and “outing myself,” the importance of this image will make sense.



So, I’ve got a buddy who is deaf (“Big D” as she calls it), and she is not the best at “reading lips.” That’s great for Hollywood scripts, she tells me, but not so great for actually carrying on a conversation. There are two things that bug her about people:


1.) When they raise their voices to talk to her, as if shouting will bring her hearing back.

2.) When people think she’s stupid, as in intellectually deficient, because her speaking voice is different than those of us whose ears collect noises and whose brains interpret the noises as sound.


These stigmas, when she was young and soon after she lost her ability to hear, had her hiding from the neighbor kids who were once her friends. After the accident that took her hearing, these “friends” became cruel, taunting, and vicious in the teasing and gossip they spread into the community that the accident made her stupid and deaf. She just wanted to hide, she just didn’t want to be with people anymore, she just wanted to die.

Now, she is a strong peer voice in the hearing impaired community (and I use the word “voice” purposely, and she likes it a lot), and she works with children with hearing impairment sharing her life stories and experiences to hopefully spare them the feeling of worthlessness and self-doubt that comes from being stigmatized.

In our chats, I shared with her that I, too, had feelings of worthlessness and self-doubt tied to my bipolar. I had a friend of two decades who stopped calling (after my wife… ex-wife now… told him I had a mental illness), I’d been fired from job after job, my marriage was a disaster and a failure, I’d been kicked out of New Mexico Tech… what I thought of myself was equivalent to what I thought of dog squeeze on the bottom of a nice pair of Nikes. I dreaded that point where someone caught whiff of me and tried to wipe me off on the lawn, the entire time cursing they ever met me… and the bottom of their shoe.

Stigmas abound beyond only medical and mental considerations. I gave a presentation to a group of kids at Polk Middle School earlier this year, and part of the presentation is asking the kids what stigmas they contend with in their lives. The typical teen-angstiness identified “We’re always on our phones,” “Everyone thinks we’re lazy,” and “All we think about is boys/girls.” I think they meant teen crushes, but I didn’t explore that one.

One young man shared a stigma that broke my heart. And, I could sense when he shared his stigma with the class that there was an implicit understanding with his peers:


“Everyone says if you live in the South Valley you’ll wind up in prison or working at Walmart.”


The quality of this stigma, the impact it had upon the class, was tangible. It was real. It was beyond “always being on the phone” or “being boy/girl crazy.” A young lady followed up saying “That’s why I never tell anyone where I go to school.” Too many of her classmates nodded in agreement.

That sense of accepted worthlessness is something I realize and understand is part of any marginalized group’s mainstay. It’s a community bond built upon a foundation of presumptions, misconceptions, and lies. These kids believe that people think less of them because of where they live, and that this stigma they overwhelmingly feel is part of their identity is a preordained limitation on what they can accomplish. I’m not too proud to say I started tearing up when I heard the kids speak about this unfair assumption.

The word “unfair” is thrown out there so much and so often that it’s all but lost meaning. It’s unfair I have to wait until Sunday to see Force Awakens. It’s unfair she got to go to the company picnic while I had to stay at work and finish billing reports. It’s unfair he buys a brand new car every year and I’m stuck driving this clunker. Given these qualifications for “unfairness,” it’s easy to see why “unfair” is a nearly worthless word.

Yet when you hear from these Polk Middle School kids, the word “unfair” is afforded a clarity all but lost in the vernacular, that the magnitude and direction of vectored fairness is so real and succinct that stigmatization is unavoidable. These kids were all a part of a leadership class, and there is no mistaking why they were chosen for this class. Their leadership talents define them so much more than the geographic locality of their community.

That’s the crux of stigmatization. It is unfair and immediate, created by an unenlightened, self-appointed mob judiciary over generations. More than that, though, is stigmas become so pervasive and saturating that the people being marginalized come to accept the prejudice, and when this happens stigmatization mutates from prejudice to shame.

What is shameful about living in the South Valley? For me, it’s a gorgeous place to walk the old trails and follow the irrigation canals between neighborhoods. The history and culture are rich and so much more a part of New Mexico’s identity than my tract housing neighborhood. For some reason, though, kids living in the South Valley are ashamed to tell other kids where they live and where they go to school, and this is baffling to me. If anything, being part of such an important community is a trophy of pride and not shame.

Looking at different stigmas, and looking at my own life living with bipolar and how I’ve often devalued myself, there is a common link expressed almost universally by marginalized groups:


Shame.


In fact, the shame is so powerful that people feel they have to hide themselves from public view and scrutiny. My Big D friend hid from kids who used to be her friends. The young lady from Polk Middle School won’t tell other kids where she goes to school. And me? I pretended that I was “normal” and dreaded that people would see the symptoms of bipolar that alter my behavior so detrimentally (read: I’m weird, I know it, and I hope nobody notices me because I just can’t handle another failed job, failed relationship, and failed self). I was ashamed of myself for having bipolar.

“In The Closet,” “Coming Out,” and “Outing Myself.” We touched on this at the beginning of this article, and as promised we’ve gotten to the reason I started the article talking about “in the closet,” “coming out,” and “outing myself.” This is a concept attributed initially to the LGBT community (I don’t know the full acronym any longer – please send me the entire list of letters if you know it and I’ll edit the text). Being “in the closet” was being homosexual and not sharing this with others. There are valid reasons for this, with the policy of the U.S. military being a fine example. “Don’t Ask, Don’t Tell” was actual policy and not just a catch phrase. Serving our country, protecting our freedom, rights, and liberty meant you couldn’t tell anyone you are gay. Where’s the logic in that? And yet there it was, and it was a policy that if you wanted to commit yourself to serving our country, it meant you couldn’t be homosexual, of if you were, you were required to hide it. It’s shameful to be gay while serving our country. It was official federal policy to keep people “in the closet.”

Now, stating proudly “I’m a guy who likes guys” or “I’m a girl who likes girls” is part of our American culture. Being “in the closet” has become more passe than “coming out of the closet.” Yet, the term remains. To share with those you love that you are gay still entails the idea of “I’m coming out of the closet,” shortened as “coming out,” and the choice and act of leaving “the closet” as “outing myself.”

I don’t like “in the closet,” “coming out,” and “outing myself” in word and concept, and this goes to the etymology of the phrase. The connotation retains the artifact consideration that “coming out” or “outing myself” meant I was hiding something that I felt was deeply shameful, and that I didn’t like who I was based upon others’ presumptions, misconceptions, and lies about what it is to be someone with bipolar.

I don’t like “in the closet,” “coming out,” and “outing myself” with such directed, purposeful zeal that it is part of my peer advocacy playbook. I don’t feel like I’ve “come out” to the public to share openly that I have bipolar. When I decided to start speaking in public about my challenges and triumphs living with bipolar, I wasn’t “outing myself.” I share openly that I have bipolar because I like who I am, and I’m hoping that my openness can inspire other peers to have the innate pride in themselves that every person on the planet has a right to.

Exactly like with “journey to recovery” versus “recovery journey” (I NEVER say “journey to recovery”), I NEVER say anywhere at anytime that me sharing my life experiences with others is the a process of being “in the closet,” “coming out,” and “outing myself.” You will NEVER hear me say “I’ve come out of the closet as someone with bipolar, and when I did I outed myself and you can, too.”

Why? Because while I felt inferior at the beginning of my recovery journey, and I felt I had to hide my shame away, the way I feel about the world and my place in it has evolved dramatically, and I’m exceptionally proud of who I am, and part of that is being a peer and a peer advocate. When I first began this peer advocacy phase of my recovery journey, I discovered in myself that I had no shame of having bipolar and I didn’t feel I had to hide my bipolar symptoms. There was no “coming out.” I didn’t “out myself.” There was only me sharing my life experiences with others in a celebration of life and all the quirky nuances that is the human condition.

So here is that photo again, zoomed in on a very specific sector of the article. “In the closet,” “coming out,” and in this article “outing myself” is not part of my vernacular, and I actively advocate removing “in the closet,” “coming out,” “outing myself” from the vocabulary of my peers.



That “outing myself” is presented in italics is a good indicator that my original article met with less-than-adept editing skills prior to publication. Sorry if anyone got the wrong impression, which many peers did at the time questioning, “Steve, ‘outing myself’ doesn’t sound like something you’d say.” Exactly. And please notice the “journey to recovery” kicking off the article as well. I covered this in an earlier “Letter to the NAMI Editor” article. “Journey to recovery” and “outing myself” in the same initial paragraph of my article are not my words or what I submitted for publication. Quality control and professional editing was not a priority for this issue of NAMI Challenger, so let this serve (vanity press) notice in lieu of a wordy editorial retraction in a future issue of NAMI Challenger.

If you’d like a copy of this NAMI Challenger issue, I’d highly recommend this specific issue. There is a very good article on WRAP, and a free WRAP class is taught at the NAMI Albuquerque office every Sunday.

Okay, so here’s the rub. I’ve learned a lot about myself as I understood more about stigmas. For you, I share a pocket-size version to take with you:


There is nothing shameful about having mental health challenges. There is nothing to hide.

And what I’ve discovered during my recovery journey is that while there are so many stigmas surrounding mental health peers, others weren’t stigmatizing me as strongly as I was stigmatizing myself.

I hope you learn something similar about yourself in your recovery journey.


Dedicated to Mary Tabor, for without your warmth, leadership, and encouragement this article would not be possible. Thank you for everything!

Reprinted with kind permission of Steve’s Thoughtcrimes.

Petitions & Peer Endorsement

As an active peer advocate in the New Mexico Behavioral Health Community over the last five years, I’ve learned there is one highly-sought commodity in our behavioral health community that is treasured over all others:


Peer Endorsement.


Any number of agencies, organizations, legislators, individuals, companies, etc. would love to get the “peer stamp of approval” for whatever product, project, or purpose they’re championing. Peer endorsement lends validity, credibility, and substance to behavioral health causes in a way no other type of endorsement can.

One way peer endorsement is achieved is through petitions. You’ve been handed a clipboard any number of times in any number of places. Heading in to vote. At the grocery store. At a sporting event. Someone knocking on your front door to ask you if “You’ve Heard the Good Word.”

The thing about petitions is the dude handing you the clipboard will give you a thirty second, rapid-fire spiel explaining what the petition is for and how you can help. It’s a thirty second sales pitch, and you’re asked to give your name in signature form at the end of that thirty seconds.

The pitch always sounds great. Sign this petition and you’ll be helping education. Sign this petition and you’ll be saying our community needs to be tough on crime. Sign this petition and you’ll be standing up to proclaim “NO WAY” to poachers who prey upon unborn gay whales.

But what can you learn in that thirty seconds that tells you exactly HOW your signature will be used? Who has access to your signature? Is the cause just or even real?

As a peer, your signature is worth its weight in gold-encrusted diamonds with a shiny platinum filling. Your signature says “I am a person living with mental health issues and I sign your petition because I believe what you say is just and true, and I want everyone to know you have my support.” Signing that petition is peer endorsement, and you’ve given it away for free with no consideration other than thirty seconds of explanatory sloganeering.


Here’s the advice: Don’t sign petitions.


There are so many reasons for this. I’ve already detailed many of them. The most important reason for passing on petitions is just this:


Your word, your voice, and your support is your greatest strength and your greatest gift to our communities.


Be sure of what you’re signing, and if you have only thirty seconds to decide, chances are the guy with the clipboard hasn’t earned your signature, your support, and your endorsement.

X__________________________________
Sign here to add your name to those who agree with everything I ever say without question! (just joking)


Reprinted with kind permission of Steve’s Thoughtcrimes

Advice for Muggles concerning AOT – Assisted Outpatient Treatment – Kendra’s Law

This will be one of the shortest articles I offer on Thoughtcrimes, and it is special advice for the Muggles in the audience.

When it comes to AOT (Assisted Outpatient Treatment), rather than trying to convince peers AOT isn’t forced treatment try sharing what AOT can do to benefit peers instead.

Start the conversation with:


I appreciate you feel AOT is forced treatment, and there might be benefits to peers being overlooked. I’d like to share my thoughts with you.


This will require some homework and analyzing AOT from a peer perspective. I feel we’re worth the effort.

You’re welcome.

Reprinted with kind permission from Steve’s Thoughtcrimes.

How did you find such a well-hidden scab, you Mind Sculptor?

I need a better opening line than “As a peer…”, like “As the superhero Indiana Jones” or “As a fleshy bag of mostly water…” this being a Star Trek The Next Generation quote. I did watch TNG for a while until this episode when Data said “Much like deep sea divers experience nitrogen narcosis, we are suffering from a form of temporal narcosis.” Because that makes a lot of sense. Time is supersaturated in the blood at great pressures and returning to STP (Standard Temperature Pressure . . . pretty much sea level in Huntington Beach), time begins to bubble out of solution in the blood forming painful, often lethal time bubbles in the blood vessels. TNG should have the temporal contemporary title Tool Time because the writers and actors are a collaboration of tools . . . who collectively think time dissolved in blood is a real thing. Tool Time. I’m out.

As a peer, there are a lot of horrible things that have happened in my life. Not getting my geology degree(s). Meeting my future wife who during the divorce told my mom on the phone, “I always get what I want, so you better say goodbye to your grandson because you won’t see him until he’s 18.” Getting fired from job after job, not knowing bipolar has the propensity to make it impossible to go to work as well as making me a complete tool when I did get to work. Tool Time!

Lots of this stuff gets pushed down, buried, ignored, dismissed, and hopefully forgotten with time. And then you get a therapist hired to help you work through the wreckage of your life, which includes the wreckage of your past sometimes. Only sometimes. And you get to therapy that week, and the therapist is thinking, “Damn, four garden variety anxiety peers today. I’m bored. Let’s see what I can do to spice up the next patient session!”

And that’s you. Or rather, that’s me. It’s been me. It’s been me too many times. Example: Somehow, my therapist once weaseled out of me that my ex-wife said, “I know all your triggers and I’m going to push every button until you kill yourself so I get full custody.” I don’t like that memory. And I had taken thirteen years to repress that particular memory and pain. But my, what a rich, painful, profitable vein to mine. So much for the successful repression.

I’m told, “Repression is unhealthy because you never come to terms with the pain and the situation, and this will continue to affect your mental heath if you don’t talk about it. You’ll never learn to handle the stress and you’ll never know how to handle the situation if you encounter it again.”

And I reply, “I taught myself how to handle it. I won’t marry Susan again. Problem solved. And thanks for somehow worming that to the front of my awareness again and getting me to talk about it for 50 minutes. You’re a Miracle Worker, where I never knew how to feel pain until you taught me. Water.”

What’s the harm in repressing pain, where’s the worry in not thinking about painful memories at the fore of the mind, how is it a crime pushing the wreckage into a tiny cube into the deepest hole in my heart where happy happy joy joy memories are a depleted uranium barrier keeping access to and from that repression from surfacing?

It takes a lot of work, repressing painful memories. Think about doing triple bypass surgery on yourself. And think about doing this even though you show no signs of heart disease, and you run marathons, and you swim La Manche to and fro just to get to work in Dover from St. Malo. My heart is healthy. And think about doing this because someone you pay to help you feel better says, “Today, I think we should crack open your sternum and play with your heart a bit.” You see what I did there? I got it around to “play with your heart” which in Hellenistic times was considered the receptacle of emotion. Clever boy.

Repression is the scab that need not be picked at. I’ve invested thirteen years worth of thrombocytes scabbing over my life with Susan. I let my bleedy nose drip all over my shirts for twelve of those years to dedicate as many thrombocytes as possible to scabbing over the open wound that was Susan. And now you want me to open that wound again? Where did you get your psych degree? Sending in four box tops from your Cheerios?

What would be ideal is to save those box tops, pour yourself a bowl of Cheerios, and while pouring your milk, notice that the picture of the “Missing Child” is a picture of Susan. And she’s been missing for thirteen years.

What am I getting around to? It’s a self-empowerment thing. It’s the ability to tell my Mind Sculptor, “We’re not going there. Let’s talk about my date last night, where the girl’s cumulative brain power for a year could toast a slice of raisin bread, but only lightly, and one side only. That’s a painful mistake that has not scabbed over with depleted uranium, and a mistake I don’t want to make any longer.” Current. Unscabbed. Worthwhile.

My therapist holds a dual role. Sacajawea and Mechanic. It’s important to have a guide into the unknown, although Lewis and Clark had no need for the lass to backtrack to last night’s camp site because one of them (Clark, because he was a directionless fool) forgot his  iPhone. It’s the current stuff I need help fixing, or at least the most current stuff that is like dragging an anchor through a sea of magnets. For me, that’s losing Clare. Not being married to the Queen of the Sirens thirteen years ago. Here is your tarnished crown, your Majesty.

My therapist says, “What should we talk about this week?”

And I say, “My inflamed hemorrhoidal tissues that have begun seeping puss and blood lately.”

And my therapist says , “What? I’m not a proctologist!”

And I say, “It’s a metaphor. The thoughts of Susan are a pain in my ass. I’m trying to repress, again, the memories of Susan you dredged out last week. Of course, people do say my head is full of shit. Perhaps I need a proctologist after all.”

– Dedicated to Stephanie’s puppy, Poppy.