William R. Marchand on "Is wellness possible?

At the end of William Marchand's Introduction to his new book, Depressions and Bipolar Disorder (Bull Publishing) he offers a message of hope: "You can expect to get well. Sometimes it takes a little time, but almost everyone with a mood disorder can get better and stay well for life."

That sounded like an extremely optimistic statement to me. I've lived with bipolar disorder for over 46 years and, although my life is reasonably good, most of the time I could not be thought of as stable. I don't think I ever have been, not for any length of time, in spite of learning how to cope well enough so I thought I had wisdom to share, which I did in my books and do in my Living Room support groups. I asked Dr. Marchand to what extent we could hope to be well. Here is his answer:

That's a great question. It is certainly true that many individuals do not achieve full remission (that is - extended periods completely free from symptoms). However - I think of being "well" as having minimal suffering. I do think it is possible to significantly decrease suffering - even when experiencing some symptoms. One approach to that is through practicing mindfulness and decreasing focus on self and symptoms and instead developing the ability to maintain moment by moment awareness of the here and now. Along with this often comes enhanced compassion for self and others as well as greater concern for the wellbeing of others and less attachment to self (also see my answer to the questions below). Of course, one may likely achieve similar results following spiritual traditions that do not involve mindfulness. That said - the evidence for the benefits of mindfulness is extensive and it can be a secular approach to recovery or a component of any spiritual/religious practice.

The book includes some very good explanations of mindfulness therapy, something I had heard about but had not had the opportunity to truly familiarize myself with. I really like how it teaches us to focus less on self. Isn't that one of the worst things about depression? That tendency to be - what I genterally call - self-centered. I've talked a fair amount in this blog about the value of othercenteredness - thinking about others instead of self.

This led to another question:

How important is it to create a meaningful life for yourself? Speaking from experience, I think I have less problems with moodswings when I know I'm doing things that will benefit other people. Maybe this is a spiritual question. I know the Bible teaches us to serve mankind and to try to make a better world. Dr. Marchand's answer?

I haven't seen any research about this - but my own clinical experience is that it is very important for individuals to be engaged in activity that feels meaningful to them. I strongly encourage altruistic activities for individuals that I work with. Along those lines - as I mentioned above, a lot of evidence (which is consistent with many spiritual traditions) indicates that decreasing attachment to self/ego is a critical component for recovery. Thus - I think enhanced concern for others and less concern for self is a key component of recovery.

I LIKE Dr. Marchand's thinking! Don't you?

New guide for recovery

It's not very often that I write about secular books here, but a new book has been drawn to my attention that I want to share with you. I highly recommend it.

Depression and Bipolar Disorder: Your Guide to Recovery (Bull Publishing) was published in May by William R. Marchand, MD. It's a comprehenisive book on the topic. You could almost call it a manual. The author himself suggests reading portions as required and not necessarily reading it cover to cover, though eventually you should try to work your way through it. There is so much good information and advice there.

The cover promises that the book will help us:

• Understand biological and psychological causes
• Become empowered to take charge of your recovery
• Find the best treatment approach for your situation

Many self-help books have been written for people with mood disorders, often by people who themselves live with a disorder, my own books included. But it's refreshing to see the topic dealt with by a psychiatrist - a book not written for other professionals, but for us, people who live with depression and bipolar disorder. Although Dr. Marchand is obviously a very learned man, being a clinician, an academic (teaching), and a researcher, the book is not hard to read.

I found the tone of the book compassionate. Obiously the author very much cares about the people he wrote it for. He wants us to benefit. He truly wants to make a difference in our lives.

Many people will say that the entire cause of our disorder is biological, but Marchand has a better explanation. Here is a sample of how he reads our disease.

"...these are biological disorders, just like diabetes and high blood pressure....mood disorders are also psychological conditions. However, in regard to brain function, 'biology' and 'psychology' are best  understood as different aspects of the same underlying processes. That said, we will likely never be able to completely reduce the complexity of human psychology to an equation describing the underlying biology. I think it is still important to recognize that biology and psychology are not opposites but rather interacting processes that cause mood symptoms." (P.116)

Another thing that interested me was Marchand's discussion of the patterns of thinking about ourselves that develop when we are depressed. He talks a bit about where they come from and about mindfulness, a therapy that can help us with this problem.

At the end of Dr. Marchand's introduction he wrote, "You can expect to get well. Sometimes it takes a little time, but almost everyone with a mood disorder can get better and stay well for life."

Wow! That is hopeful news, isn't it? I wasn't sure whether I could accept that. So I sent Dr. Marchand some questions. In the next post I will publish his response to me on this and a few other things.

Lithium and tremors

I haven't written here for a while (sorry), but a bunch of things are piling up and I expect to write a fair amount in the next week or so. This includes a review of a new book by William R. Marchand, MD. Depression and Bipolar Disorder: Your Guide to Recovery. I very much recommend it and will talk about it in future posts.

But the uppermost thing on my mind right now - something that has been such a pain - is the tremors I've had since I started Lithium. I've had tremors for years. Maybe essential tremors; maybe because of meds. But five months ago when I started lithium the tremors became so pronounced that it's hard to write or to photograph children. Both activities that are such an important part of my life.

IT'S A HUGE PAIN!!

A couple of weeks ago I was pouring boiling water into a carafe and I had one of the jerky tremors I often have and poured the water on my wrist instead. It created a nasty burn. My legs are affected as well. Last week I was trying to help some people out carrying things down some stairs. I had to give up because I almost fell several times - just could not do those stairs without hanging onto the bannister. I have a hard time doing the circuit at the gym, because changing machines is such a clumsy ordeal for me. Speaking engagements can be embarrassing as well. People think I'm looking awfully nervous and that's embarrassing. As a result, I get more nervous than I would otherwise.

THIS IS MAKING ME FEEL SO OLD AND HANDICAPPED!!

I'm preparing to do some entertaining today and the stress of it is increasing the tremors. How am I going to manage slicing the fruit to decorate the frozen cheesecake I'm making? Or chop the broccoli? I just got some new sharp knives and now I am afraid of using them. I'll have to ask for my husband's help. Yet I know he's getting tired of me becoming more and more dependent on him.

IS IT WORTH IT?

Yet the lithium has kept my mood so beautifully stable since I started taking it. What if I came off it and were to go on another less effective drug? What if I were to return to the rapid cycling I was experiencing before I went on it? No way would I want to go back there.

Maybe I should go on yet another drug - a beta-blocker to reduce the tremors. Some people have good success on them. I've tried propranolol but didn't like what it did to me. Maybe there's one that would work better?

Or should I just aceept this and live with it? I recently read Michael J. Fox's story. Isn't he a lot worso off than me? Yet look at how well he accepts it.

Have you had such problems with lithium? What did you do about them?