The Narrowing of Normal

Years ago I was on a work team with a colleague who, as it became increasingly apparent, was bipolar. During a manic phase, she promised a non-profit organization close to half a million dollars for a project which had yet to go through the corporate approval process. When the team business manager caught wind of it, she called our colleague on the carpet. “You can’t promise money for something that’s not approved. There are policies! There are SOPs! We don’t even know if half a million is fair market value!” The conversation escalated. There was a call with our manager. Our colleague refused to back down. She’d promised the money. She was going to deliver. We would find a way to make it happen or she would quit. In the end, that’s exactly what she did.

In the aftermath, there were a lot of closed door conversations between teammates about what the heck just happened. Dr. C. who’d once done a psychiatric residency, commented rather smugly, “She was clearly bipolar. But she’s not the only one on our team who’s not normal. I’ve got a diagnosis for every one of you.”

Hmm. Not exactly what I was hoping to get from my Secret Santa.

I’ve always thought I might be a little defective. How could I not be, given the murkiness of my gene pool? When Jeff, a therapist I saw after Jerri’s tumultuous arrival in Durham, asked me, “how did you manage to turn out so normal?”, I suspected sarcasm. Either that or he just wasn’t very good at his job.

Then today, while surfing, I stumbled upon this great news. It’s not just me. We may soon be living in a culture where very few people are free from psychological defect. According to this article at Psychology Today, the fate of normalcy hangs very much in the balance. With the increasing ability of technology to see us as we’ve never been seen before comes expanded diagnosis. Mental disorders are encroaching on more and more territory. The National Institute of Mental Health estimates that half of us will have a mental disorder in our lifetime.

I’m not too concerned about the fate of normal. I once told Bruce, a friend and colleague, that I was’t even sure there was such a thing. “Who gets to decide what’s normal anyway? Normal means common, typical, usual, standard. Who’s to say what is and isn’t? Maybe normal is just a myth. Maybe it doesn’t even exist.”

20120830-113811.jpg“Sure it does, Terri. Normal exists. It’s a town in Illinois. And guess who was born there?” He rocked both thumbs back toward his chest. “Yep, you got it. Poster boy for Normal here. Where. I. was. born.”

Okay. Maybe so, but I want to see the birth certificate.

The article goes on to say we’ve already narrowed the bounds of normal to the point that doctors are now “treating” personality traits which are normal but considered undesirable by the patient:

As Lane writes, “We’ve narrowed healthy behavior so dramatically that our quirks and eccentricities—the normal emotional range of adolescence and adulthood—have become problems we fear and expect drugs to fix.” Psychiatry’s critics also complain that doctors medicate patients who meet no diagnosis, who practice what I have dubbed “cosmetic psychopharmacology,” to move a person from one normal, but disfavored personality state, like humility and diffidence, to another normal, but rewarded state, like self-assertion.

This is a conversation I’ve had with my sister. “I neeeeeeed that medication,” she says. “Without it I can’t focus. My mind is constantly racing. Always thinking, thinking, thinking. And I can’t shut it off. When I don’t have THAT medicine, I have no interest in gaming. It’s not even fun. But when I take it, my mind quiets down and I can play games all day long.”

“My mind is always thinking too, Jerri. That’s normal. It’s what minds do.”

“Really?” She seems confused. “You think ALL the time? Your mind never shuts off?”

“Yep. And – news flash – I don’t enjoy gaming. I’ve never thought it was fun. It’s just not my thing. Maybe it’s not yours either.”

“Or maybe, you have a milder form of what I do. Maybe you’re bipolar too.”

And according to the article, she may be right.

Recently, I broached the whole self-medicating-to-change-who-you-really-are thing with my nail technician and she confessed to “trying” her son’s ADHD medication so she could “understand what he experiences when he takes it.” Uh huh. She said everything became so much sharper for her. She was able to understand things that had previously eluded her. She wondered if she, too, has ADHD. Her son said when he takes the medication, he can understand mathematical concepts that he can’t without it. He doesn’t take the medication all the time but he will ask for it when his class is studying a particularly difficult subject. She concluded by saying, “I’m glad he’s willing to do what he needs to in order to succeed.” This seems completely whacked-or is it just me?

The article goes on to say that because computers have the ability to identify varying degrees of severity for hundreds of factors associated with different diagnoses, we are likely approaching a future where we find we are all defective to one degree or another. So yay! We can all breath a collective sigh of relief. Pretty soon there will be nowhere to hide. We can all just stop pretending. We will soon be free to walk about the cabin as our crazy, wacky selves. Normal, as we know it, may soon cease to exist. If it ever did. Except in Illinois.

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Perceptions of Perception

20120821-233647.jpgThere’s an interesting new show on Monday nights (10 pm ET) on TNT. Perception stars Eric McCormack (of Will and Grace fame) as Dr. Daniel Pierce, a neuroscience professor with paranoid schizophrenia who works with the FBI to help solve complex cases. His hallucinations actually help him discover the truth as they reveal connections that his conscious mind hasn’t yet processed. If you’ve ever worked through a real life problem in a dream and woken up with the answer, this doesn’t seem all that far-fetched.

I’m always fascinated by TV series and movies that feature characters with brain disorders. Monk and As Good As It Gets have lead characters with OCD and based on my experience, give a pretty accurate portrayal of the impact this disorder can have. I adored A Beautiful Mind which I assume is reasonably accurate since it’s based on the biography of John Nash. Moving to the opposite end of the “believability” spectrum is Fringe which features a “mad scientist”, Dr. Walter Bishop, who suffers from a unidentified brain disorder which, we learn, is likely a result of a lobectomy that his former friend and colleague performed (taking the concept of “losing one’s mind” to a whole different level).

One of the things all these stories have in common is the way they endear us (Melvin Udall aside) to the mentally ill. They help us see people with brain disorders not as freaks or homicidal maniacs, but as real people struggling to work and live meaningful lives despite their illness. I believe shows like these may have the power, over time, to help eliminate the stigma associated with mental illness.

On the other hand, it concerns me that Perception leads viewers to believe a person with schizophrenia can stop taking his meds and still be highly functioning. Dr. Pierce refuses to take medications for his schizophrenia, (he views it as a gift) yet he is still able to teach at a University level. Like with most illnesses, I’m sure people who have schizophrenia suffer different degrees of impairment. The few people I know, however, go off the grid when they stop taking their meds. They wind up homeless, muttering incessantly, unable to take even the most basic care of themselves. Of course if Dr. Pierce WAS taking meds, he probably wouldn’t hallucinate and we’d be left with just another murder/suspense drama with a really smart expert consultant not unlike Bones but with less-decayed victims.

Anyway, season 1 of Perception began July 9th and has already been renewed for next year. Episodes (starting with 3) can be watched at TNTdrama by customers of certain TV providers (Charter, AT&T, Dish, DirectTV, Comcast, a few others but NOT Time Warner). All episodes can be purchased at Vudu, Amazon, or iTunes. If you’ve been watching or decide to check it out, let me know what you think. I’d particularly like to hear from those of you with loved ones who have schizophrenia.


Stuck

Jerri, in her right-mindedness, is thinking about making some life improvements. She would like to move into a better neighborhood where dealers don’t make door-to-door sales calls. Also, Housing for New Hope recently terminated the housing agreements for a number of tenets in her apartment building and while she makes an effort to follow the rules, she is tired of worrying that she will be the next one to go. So Jerri recently applied for another subsidized housing community in the north part of town.

The application asked if she had ever been charged with a felony. Unfortunately, Jerri had to respond yes. Twenty years ago, when she was 29 and a practicing addict, she broke into our parent’s house and stole a TV. Mom reported it and Jerri was charged with larceny. She was put on probation and required to do community service. Jerri considered lying on the application but to her credit, she decided it was best to tell the truth (which, BTW, is google-accessible for anyone industrious enough to check). She hoped that the two decades of felony-free living since would weigh in her favor.

Apparently, it did not. Her housing application was denied.

Jerri is also considering applying for a part-time job. She can barely make ends meet on her disability check and in order to save money for a scooter, she is eating at the shelter and ear-marking her grocery money for the purchase. The problem with getting a job, however, is it puts her disability payment in jeopardy. I haven’t researched the rules (and if you know them, please share), but I’m told her disability check will be reduced by the amount of money she makes and when her income reaches a certain amount she will lose disability altogether. Which means she will also lose Medicaid. We could live with that if we knew she was going to a) remain stable and b) be able to hold down a job and c) make enough money to afford Medicare.

I’m not sure she can even get a job. There’s the issue of the felony for one thing. Every job application includes a question on criminal record. She has no recent job experience and she also needs to work on her personal appearance. Whether we like it or not, others judge us on our appearance and particularly when assessing us for a job. For years Jerri has been too overwhelmed with symptoms to care about personal hygiene and this has taken a toll on her teeth, hair, and nails.

I read a fascinating memoir over the weekend, Signs of Life and the following observation by the author, Natalie Taylor, really resounded:

I never realized that certain people really are stuck. And they are not stuck because they don’t work hard or because they don’t want to get out of where they are. They’re stuck because certain forces in the world won’t let them out.

I think a lot of people with brain disorders, Jerri included, are stuck even after they recover. Many of them have police records because of things they did when not in their right mind. They can’t explain the gaps in their job history because that requires touching on the taboo mental illness topic. They’ve lost touch with the norms of basic etiquette and personal hygiene. And in the US, they are reliant on social systems that don’t support easing out of disability and back into the workforce.

Is there any hope for them? Really interested in your point of view. Am I missing something?


Breaking the Stability Code

We dropped by Triangle Cycles this week so Jerri could check out the scooters and afterward, as we drove back to her apartment, she asked “Where’s my Nicotrol Inhaler?”

I was stunned. You see last week, Jerri left the inhaler in my car. She called later to verify it was there and told me not to bother bringing it back since she had another one at her apartment. She’d just get it from me next time. And here it was, Next Time, and she remembered. She actually remembered, without any prompting, something that I, myself, had forgotten. Her inhaler was still in my car. This might seem trivial to others, but Jerri’s inability to keep up with her things is a constant source of consternation. Stuff seemingly disappears and she has no idea where or how she lost it. She can’t remember where she put her keys or that dollar she was saving for laundry. And that’s not the half of it. She often leaves voice messages asking me to remember something she knows she won’t.

But now, she’s very present and in her right mind. The improved memory is just one indication. Last week she surfed the internet for the best scooter deals and put together a plan to save up money to buy one. Her brain is working better. But how the heck did that happen? Seriously. I wish I could break the code. You can’t replicate what you don’t understand. If we could only figure out what she is doing right, maybe she could stay stable and actually start living life. There is something in me that refuses to believe Jerri is broken for good.

She’s been stable for about 3 months. Looking back, that aligns with, you guessed it, the day Dr. F stopped prescribing the-drug-of-which-we-do-not-speak. Jerri was very upset at having her access cut off. “I can’t focus without it! I can’t do anything. I neeeeeeed it to think clearly.” So I suggested we go to GNC and look for a natural supplement to help her concentrate.

Honestly, I don’t think concentration is her problem. And I’m not a big believer in nutraceuticals. It just feels like snake oil, you know? But it’s not all hooey because my knees scream at me whenever I fail to take Glucosamine more than 2 days in a row. It’s hard not to believe screaming knees. Jerri, on the other hand, puts a lot of faith in pills. She believes there’s a magic combination that, if she could only find it, would make her completely normal again. Doesn’t matter if it’s street drugs, prescription, or nutraceutical. So, while I really didn’t expect to find something that would help her, I thought trying something would at least help her feel like all was not lost. And maybe postpone her looking for another doc who would prescribe that demon med.

The GNC clerk showed us various products recommended for people with ADHD. Memorall, for one, is supposed to improve memory and focus. Sitting on the same shelf, was Energy Enhancer, a GNC product to boost energy levels. While I contemplated Memorall, Jerri picked up EE and said, “This is what I really need. Something that will get me out of bed in the morning.” She has been taking it religiously ever since and while she’d swap it in a heartbeat for the-drug-of-which-we-do-not-speak, she always let’s me know when she’s low on EE to make sure she is never without it.

So could Energy Enhancer be responsible for her better brain function? Or perhaps just her faith in it? Belief is, afterall, a powerful thing. Or was the simple act of ridding her system of that demon med the catalyst?

Hmmm. It’s got me thinking. What if some brain disorders are a result of vitamin deficiencies? When I was studying epilepsy at work, I learned a lot about how the brain works. Potassium, sodium, calcium, and other minerals found in our food are essential to the proper operation of mechanisms that cause neurons to fire. If neurons don’t fire or fire repeatedly, it messes up the chemical balance in the brain. Which causes seizures, or depression, or other brain disorders. So it stands to reason that if you aren’t getting some nutrient vital to brain function, you could get a little nutty.

20120805-211426.jpgI’ve had personal experience with vitamin deficiencies and know how life altering they can be. As a kid, I had a terrible time staying awake. The problem was so bad, my kindergarten teacher told Mom they were not going to promote me to first grade. Since I couldn’t stay awake, I wasn’t mature enough to move up. My BFF Karen Kay’s mother took mine by the hand and said, “It isn’t maturity, it’s nutrition.” They began pumping me with chewable vitamin C tablets, orange juice, sardines, and peanut butter. I call it the special Kay diet. And it worked.

My vitamin deficiency made me sleep all the time. But Jerri had the opposite problem as a kid. She had a terrible time going to sleep. There’s a link between bipolar disorder and sleep. Lack of sleep triggers mania which then leads to sleep deprivation. Interesting, right? If increasing certain foods in my diet fixed my sleep issue, maybe it could also help with insomnia and prevent mania. So I googled Bipolar and Nutrition and found a great article at PsychCentral.com. It states:

Experts from the Global Neuroscience Initiative Foundation in Los Angeles report that people with bipolar disorder are more likely to have vitamin B deficiencies, anemia, omega-3 fatty acid deficiencies, and vitamin C deficiency. They believe that essential vitamin supplements, taken alongside lithium, “reduce depressive and manic symptoms of patients suffering from bipolar disorder.” However, many of these links, although biologically plausible, are still unconfirmed.

In recent years, several studies have investigated the importance of folic acid in bipolar disorder. Deficiency of folic acid (vitamin B9, known in the body as folate) can increase levels of homocysteine. Raised homocysteine has been strongly linked to depression and less strongly to bipolar disorder.

What’s REALLY interesting is how the vitamin deficiencies listed in the article line up with the nutrients in my special Kay diet. Peanut Butter contains niacin (B3), folate, and B6. Orange juice is high in C. Sardines are high in B12 and omega-3 fatty acids.

Think about it. As kids, Jerri and I had the same diet. If my pre-special Kay diet lacked these nutrients, then so did Jerri’s. Or perhaps, genetically, we’re wired to need more of these nutrients. (Our Mom has to take B-12 injections because her body doesn’t metabolize it properly and she gets fuzzy-headed and at times incoherent.) In me, the deficiency caused sleep disorder. Perhaps in Jerri, it causes mood disorder.

Energy Enhancer, BTW, is primarily composed of niacin (B3), L-Arginine, and grape seed extract. Jerri also added a B-complex vitamin.

So I’m wondering how Jerri would do on the special Kay diet. I think it’s time for a little experiment.