A Primer on Depression and Bipolar Disorder

B. Qualifications

At this point it is logical to establish my "credentials'' for writing this essay. First, I am not a doctor, psychiatrist, psychologist, or social worker. Likewise I am not qualified as a research worker in this field. Therefore you should not take what I write as medical advice; it is based only on personal experience. Always consult with your physician before you undertake any new treatment regimen or alter an old one. I am a layman in the field. Nevertheless I am an "expert'' because I have had bipolar disorder for 46 years, and suffered with it, sometimes intensely, for 42 of those 46. I have also gotten to know a large number of other people with CMI , mostly with bipolar disorder. We all know the illness "inside-out''. And we all have had experiences we can share with others to guide them in their own struggles with mental illness, whether first-hand, or in helping a friend or relative.

So allow me to sketch here the course of my own illness. It has been a long journey since its first recognizable manifestation when I was 16, to its ultimate definitive diagnosis as bipolar disorder when I was 47 in 1986. From the ages of 16 through 20 I was an undergraduate at UCLA. During those four years I experienced the tremendous energy of very mild mania (hypomania), and was able to do things like take a triple major (astronomy, mathematics, physics) while getting all A's. At the time I thought that that was just my ``normal'' state; but in retrospect I can see all of the hallmarks of mania.

In graduate school at Caltech I had my first episode of depression when I was 21. I felt unhappy, discouraged, helpless, hopeless. Compared to my more recent experiences it was a mild-to-moderate episode, but at the time it seemed awful. The treatment I was offered was ineffective (really very little was known about treating depression then!); eventually the depression faded away. From the age of 24, when I completed graduate school, to 46, I had many ups and downs, sometimes hypomanic for a year or two, sometimes depressed for a similar period. During this entire time I had no idea of what the nature of my ``problem'' was. Nonetheless I was able to have an active and successful research and teaching career at Princeton University, University of Chicago, University of Colorado, and the National Center for Atmospheric Research.

In the Fall of 1985 my wife and I moved to the University of Illinois. That was the trigger for a rapid (!) descent into the worst depression I have ever experienced. It was extreme misery: I was unable to think or concentrate (I was literally unable to read a newspaper); I felt utterly worthless, incompetent, and a failure; I would have nightmares of being sentenced to death; then I would lie awake for most of the night in extreme anxiety; I got out of bed in the morning only with the greatest of difficulty; I enjoyed nothing; I was in deep despair. I consulted a psychiatrist, who prescribed a medication that he believed was an antidepressant. We know today that the medication he prescribed is not an antidepressant, but a tranquilizer. Naturally, it didn't work.

In early December 1985 I crashed yet farther down and became suicidal: a quiet little voice in my mind started telling me that my condition was hopeless, and would not, could not, change; that there was only one way out, death; and that the time to take that exit was now. This went on relentlessly, over and over, hundreds of times per day. During the first week of January 1986, I returned home early one afternoon to take my gun and kill myself. But I couldn't find the gun (I found out later that my wife had removed it from the house on the psychiatrist's advice), so I was thwarted; I was in such a poor mental condition at the time that I couldn't even think of another plan! A short time later I had an experience, which I will describe below, that convinced me that it is ethically indefensible to suicide, so I resolved to tough it out to the bitter end, whatever that might be, without taking the ``back door'' out.

I struggled onward with the same doctor and the same medication until the end of May 1986. Both I and my wife repeatedly complained to him that the medication was doing no good whatsoever; possibly it was making matters worse. He complacently assured us that it really was doing some good, that he could see the improvement ``from the outside'' even if I couldn't see it ``from the inside''. I was right and he was wrong. Indeed, had I known then what I know now I would have insisted that he try another medication (and yet another if necessary) until we finally found one that actually did work. And if he had refused, I would have found another doctor, fast! But I didn't know the ropes yet, and I accepted his authority blindly. I hope that no one who reads this document will ever make that mistake; it is, after all, a matter of life or death; perhaps your life or death. In retrospect I believe that this particular psychiatrist is incompetent with medication. He meant well, and he offered me a lot of support through ``talk therapy''; but he didn't even try to do his job with the most critical part of the treatment -- the medication. To this day I will never recommend him to anyone with a biogenic (see definition of this term on p. 7) mental illness.