THE COMPASS “ Tools and Inspiration for People The Compass is published 4 times a year With Mood Disorders” on the third Tuesdays of the following A Mental Health Quarterly in the months: Greater Philadelphia Area The Compass is a publication of New January – April – July – October. Directions, a support and education Fall 2003, Vol. 16, No. 3 group for people with mood disorders Circulation: 2,500 mailed to subscribers, and their families & friends. Mood physicians, therapists, private and A Publication of community mental health centers, drop-in New Directions Support Group, Inc. disorders – depression and bipolar centers, consumer and family support Abington, PA disorder – are genetically- groups, and national organizations. predisposed, environmentally- Mailing Address: triggered central nervous system The Compass is a copyrighted publication P.O. Box 181 disorders that respond well to of New Directions Support Group, Inc. of Hatboro, PA 19040 medication and therapy. We meet the Abington, PA. It is published through an extremely generous contribution from Contact us at 215-659-2366 first and third Tuesdays of the month Janssen Pharmaceutica Products, LP. We [email protected] at Abington Presbyterian Church, also wish to thank the Patricia Kind www.NewDirectionsSupport.org 1082 Old York Road, Abington, PA, Family Foundation and our from 7:30 PM to 9:45 PM. To readers/subscribers. We love hearing from you! register, please call 215-659-2366, ext. 1. Editor: Ruth Deming Inside this Issue: Assistant Editor: Simon Baniewicz New Directions is affiliated with the Production Staff: Mary Begis, Joan Guest Speakers -1 Entenman, Ada Moss Fleisher, Bernice Editor’s Corner -1 national DBSA (Depression and Greenwold, Ellen Greenwold, Harvey Pfeffer, Letters to the Editor -3 Bipolar Support Alliance) –NAMI Amy Russell, Freda Samuels, Janet Taylor Tasty Nuggets -4 PA (National Association for the Graphic Layout: E. Hunt Researchers: Ellen Bulletin Board -4 Mentally Ill, PA state chapter) - Greenwold, Mike DiMarcantonio Gold Pages: Mornings at the Mall -6 Mike DiMarcantonio, research editor Ada’s Outing -6 member of the Abington Memorial Professional advisors: Beth Kelly, LCSW; Ask The Compass -7 Hospital Referral Network - and Edie Mannion, MFT; Billie Lee Orenbuch, Mrs. Olson -7 works in cooperation with the LCSW; Sharon Piercy, RN; Linda Jenofsky, Our Daughter’s in Trouble -8 Montgomery County (PA) Office of MS, M.Ed Just Folks -9 Medical advisors: Wade Berrettini, MD, PhD; Our Favorite Iconoclasts -9 Mental Health. Laszlo Gyulai, MD; Pamela London-Barrett, Queen of Thrift -9 DO; Richard Fleisher, DO; Laurence M. Letter From Mark Davis -10 Many thanks to our contributors who Schwartz, MD Love and Marriage -11 widen our understanding of mental Our Nancy -12 illness and of ourselves. We welcome Notes From A Therapist -13 Cover: Carl Yeager Billie Lee Orenbuch 13 contributions. Send manuscripts to Cover Photo: Destiny, Photo taken in Bucks Healing Arts -14 above address. To protect County, PA. 1974. Realized October 19th Ask Dr. Berrettini -14 confidentiality, composites may be 2003. Pet Therapy -15 used instead of actual people. The Dr. Gomberg -16 “What is my destiny in life and should I know Kay Jamison says… -17 Compass refers to a variety of when it has arrived? Do I have more than one Our Favorite Pharmacists -18 medications in order to educate our and if so how does one recognize them and Joel Shuster -18 readers to the variety of medication cherish them? What is my path destined to be Larry DiBello -19 available. We remind readers of the when there are so many questions with so little Our Man in Neuropsychology -21 answers? Perhaps only another can tell me of Gregory D. Perri, PsyD wide variation of medications on my fate. Is this the one who waits at the end of Department of Amazing Stories -21 different people. As always, check this covered path?” Bob M. - 21 with your trusted physician to find - Carl Yeager Humor -23 whether a medication may be suitable Phyllis Lewy - 23 Pursue the Wonderful -23 for you. None of the articles printed Carolyn Constable - 23 here is a substitute for consulting Kaleidoscope your physician The Compass does not endorse or Gold Pages recommend the use of any specific medication, product or treatment.

1 No reservations necessary! Who knows where the Compass goes?

…. The Patricia Kind Family Foundation GUEST SPEAKERS People who believe in you give you courage and Everyone is welcome at New Directions’ Speaker confidence to continue your work. The Patricia Kind Programs. They are held the 3rd Tuesday of every Family Foundation, one of the great philanthropic month at our regular meeting place – Abington organizations in the Delaware Valley, gave us two Presbyterian Church, 1082 Old York Road at extraordinarily generous grants. The money was Susquehanna, Abington, PA – from 7:45 PM to 8:30 certainly important. No more monetary constraints at PM. Our Small Group Discussions are held afterward. Kinko’s. But perhaps more so was the validation by To verify that the speaker program hasn’t been important community leaders that New Directions changed, listen to our recording at: 215-659-2366 ext. makes a difference in the world of mental health. 3. For directions, call Nick Breslin at 215-886-8628. Thank you, PKFF.

November 18… Becky Shoulberg, MSW, marketing We can make even more of a difference with our outreach specialist, Eagleville Hospital, “Substance readers’ help. The Kind Foundation will match any Abuse and Mood Disorders.” contributions you, our readers and members, send us. What an opportunity! December 16… Diane Allen, personal coach, “Learning Lessons from The Wizard of Oz” Take a moment to consider what New Directions and (rescheduled from earlier). The Compass – two famous Philadelphia traditions - have meant to you. Look through these pages and see January 20… Betty Degnan, RN, MSN, and Reiki all our wonderful offerings. People have looked toward Master, “Mind/Body Integration,” Abington Memorial New Directions since 1986 as a beacon of hope. And to Hospital’s Integrated Medical Services. the Compass as their “arm-chair support group.” Thanks to the Kind Foundation, we’re able to continue February 17… Dr. J. Russell Ramsey, Center for the work that’s needed in the Philadelphia area. Cognitive Therapy, University of PA, “How Cognitive Therapy Can Help People with Mood Disorders.” If all of this rings true to you, mail us a generous donation. Make a check out payable to “New Directions.” Do it now. Before your forget. We’ve gotten checks ranging from $3 to $1,000. Our address is: New Directions EDITOR’S CORNER PO Box 181 by Ruth Deming Hatboro, PA 19040 New Directions And, as you write your check, remember it’s actually A gigantic thanks to: double the amount you’re writing it for. Who could ask for anything more? …. Janssen Pharmaceutica Join in the excitement. Be a part of our team. Our The Compass would still be sitting in the editor’s support group needs your support. computer – or, worse yet, in her already stuffed head - if it weren’t for the generosity of the folks at Janssen in printing up the Compass: Tom Gudusky and Marianne Sullivan who said Yes to our original …. The man in the Double Helix necktie request, and to Ed Quispe, our printer extraordinaire. When people ask me, “Who reads the Compass?” I If we don’t thank our professional advisor - Dr. Wade remember what Ed once told me. “I finally got a Berrettini of the University of Pennsylvania - for his chance to sit down and read the Compass. I was on the generous support and gentle encouragement we should plane going home to Peru. When I got off, the guy get our head examined. He’s always been there for us, sitting next to me asked if he could read it, too, so I answering our smallest questions (“Wade, should I put passed it along to him.” this in the Compass?”) - even while he’s solving the mysteries of the universe in his white lab coat: the

2 DNA that made us all. Read his column later in these we’re fond of saying, can be made even in the smallest pages. steps. Even Mary Ellen, herself, recounts her early years of desperation and despair. And her tenacious You did the right thing, Denis battle to get well.

A wonderful friend of ours, Denis Hazam, called to say Let me share another story of recovery I heard while he’d 302’d a friend. “Involuntary commitment,” it’s having lunch at the Reading Terminal Market. Seats officially called. That means that Denis had witnessed were at a premium and a woman sat down next to me. first-hand that “Charlie” was overcome by his mental Like a stranger on a train, she began pouring out her illness, wasn’t aware of it, and needed hospitalization story to me. Ten years earlier, she’d been a battered for life-preserving treatment. wife, physically and emotionally. The words “Just leave him” had no effect. The bonds of attachment, We didn’t have to ask Denis why he was calling for someone once said, are stronger than those of love. support. It’s one of the most difficult decisions a person Finally, with a plan in place, she left her husband. How can make. Questions arise about our own judgment and did she do it? “Faith in God,” she said. “I never could competence: Am I qualified to make a decision? Are have done it without God’s help.” They have an my perceptions correct? Is the other person truly in unswerving relationship. need of help? Finally, what are the consequences if Charlie won’t get help?

It’s a soul-searching process. A person must look the truth in the face and then act on it. DBSA PA

Luckily, a neutral arbiter makes the final decision. The national DBSA (Depression and Bipolar Support Alliance) – which boasts a thousand chapters across the As a friend, we reassured Denis that he had done the country - is now establishing state chapters. A month right thing. ago, “DBSA PA” became official. As an independent affiliate, New Directions is proud to be a part of their (Denis is head of DBSA HUP – Depression & Bipolar team. Our motto is: The more organizations Support Alliance of the Hospital of the University of collaborating together, the quicker things will get done. Pennsylvania. He and his wife Fran run a group known for its compassion and caring, due, of course, to its DBSA has a terrific informative web site. New on their leadership.) web (www.DBSAlliance.org) is a valuable book for kids with bipolar: “The Storm in My Brain.” Check it out!

Dare to reach your potential!

“ I have to meet the challenge of keeping myself Cognitive Limitations balanced on a daily basis. I have to use every ounce of my creativity to find coping mechanisms and solutions The first step in getting better is to know what’s wrong that keep me stable.” with us. It may be scary at first. But the more we know about ourselves, the more we can correct what’s gone Those words, from “Living without Depression and wrong…. and devise wellness techniques to keep us in Manic Depression,” were written by Mary Ellen balance. Copeland, a master of self-help and recovery, who also has bipolar disorder. Her workbooks should be in the Part of our condition may include “cognitive” home or the mind of everyone who aspires to reach limitations. It’s important to acknowledge this. their fullest potential possible as a person with a mood Cognition refers to our ability to think, to remember, to disorder. solve problems, to process information. (We’ve included an important article in these pages by Dr. It’s not easy. But because so many people with bipolar Greg Perri, a neuropsychologist, who gives us a brief disorder or depression are successful - doctors, introduction on how our minds are affected by stress.) lawyers, business owners, secretaries - there is no reason why any of us should give in to the illness- If you are interested in pursuing further information fostered sense of hopelessness and defeat. Recovery, as about cognitive limitations, you can start by viewing an

3 easy-to-read handbook recommended by Alice Fitzcharles of NAMI Main Line: “Dealing with As far as OCD, I do hope the media gets around to it. Cognitive Dysfunction Associated with Psychiatric Take geniuses, for example I once wrote a piece on Disabilities: A Handbook for Families and Friends of Gregor Mendel: An Austrian monk with a penchant Individuals with Psychiatric Disorders” by Alice for getting to the root of things. Talk about obsessing! Medalia and Nadine Revheim. Do you know how many peas this father of genetics experimented on? Something like 15,000! Visit http://www.omh.state.ny.us, and click on “Resources.” That’s what it takes to make a genius. The ability to obsess well and be compulsive about it. In Mendel’s case his obsessions were two: God and peas. They endured Ruth Deming, MGPGP, is founder/director of New I’ve always called her “Beautiful Edie.” Like many Directions Support Group. She was diagnosed with people passing through New Directions, she called and bipolar disorder in 1984 and lives in Willow Grove, wants to say hello to all her friends up here. Folks will PA. remember Edie as head of two Project Share Drop-in Centers - and one of the first people to carry around a . . . . . cell phone. Italicized inserts: “Relatively funny stories.” Thanks To look at Edie, you can’t detect the fierce mood to Russ, Greg, Dan, Shelly, and Judy. swings she’s endured her whole life. She’s been able to work – taking leaves of absences when necessary – and * developed a lasting and loving relationship with a man, also with mood swings. “Paul” and Edie married. Together they persevered through the nasty side of “ Hey, Jude!” I used to work as a telephone survey mood swings: marital instability, moving in with solicitor. The object was to have the person answer a relatives, money problems, job problems. They always list of 30 questions. You’d tell the person that the call pushed through. At 41, Edie gave birth to a daughter, would take 15 minutes though in reality it took 30. If while their life moved forward. you could get through the first 10 minutes, there was a good chance of finishing up the interview. One time I The miracle is that through it all, they endured. They had this guy on the phone who agreed to answer the live a normal life. And do normal things. They’re just questions if I’d listen to him play some songs on the like everybody else: human beings facing the guitar. They weren’t that bad. challenges that life throws in our path. * Every human being has mood swings. Ours are exaggerated to the extreme.

Our favorite mental illnesses . . .LETTERS TO THE EDITOR. . . .

Though I try not to show favoritism, I have to confess my two favorite mental illnesses, from the viewpoint of I AM WRITING to thank you for sharing your an insider, are Bipolar Disorder and OCD. I’m also newsletter with us. It is filled with practical partial to borderline personality disorder and information. The Compass has been a useful resource schizophrenia. When New Directions sponsored its for patients and their families and also for staff. Some recent program on borderline personality disorder, I have found inspiration in the personal stories and couldn’t help but notice how many traits people with accounts of recovery. Others have found the strategies BPD and BP share in common. Edie Mannion of the for coping and staying well invaluable. The diagnostic TEC Family Center, who co-sponsored the event, and medication information is clear and succinct. We believes as I do that Borderline and Bipolar are sisters are grateful for the opportunity to continue to receive on the Bipolar Spectrum. It’s all a matter of degree. the Compass. The men and women who suffer from these conditions, as do artists, are people who possess an “exquisitely Chris Ockenlaeder sensitive mind.” Coordinator, Allied Therapies

4 Abington (PA) Memorial Hospital

ABINGTON TOWNSHIP PUBLIC LIBRARY was indeed fortunate to host the New Directions’ Display Case in October on “Teen Depression.” This is a most important topic that affects many families in our community. Our Library is pleased to help bring the situation to light, especially since we have 1,200 patrons visiting daily. Of particular help was the comprehensive resource list you provided for patrons wishing follow-up. We look forward to working with you again.

Nancy Hammeke Marshall, Director Abington Township Public Library Encore! Encore! Fifty people from the community attended a program with the enticing title of “Borderline Personality Disorder Embodied in the . . . . .TASTY NUGGETS. . . . . Creative Genius of Janis Joplin and Jim Morrison.” The program, held at the Lower Moreland Community Center in October, was sponsored by New Directions What we’ve been waiting for! “Support Support Group (see director lying on table) and the Group for Consumers,” sponsored by NAMI PA, is a TEC Family Center (director and former trumpet monthly daytime meeting at Bryn Mawr Hospital. player Edie Mannion, third gal on left). Program Format: First half hour: topic discussion. Next, presenters were Dr. Gerald A. Faris, left, and his personal sharing of “here and now” issues. Emphasis brother, Dr. Ralph M. Faris, right. They discussed their on the “wisdom of the group.” Interested members important new book “Living in the Dead Zone,” must interview first with Carol Carlen, 610-649-6844. available on the web. Also shown are speaker Dr. Remember, “I’m not my disease.” Pamela London-Barrett on left; Shelly Quigley William I. Packard, MD, former director of inpatient (center) and hostess Ada Fleisher on right who supplied psychiatry at Bryn Mawr Hospital, is a scheduled the coffee and Danish. The program was funded by Eli speaker at the NAMI Main Line. His talk, “Caring for Lilly & Company. the Whole Person: A Psychiatrist’s Perspective,” focuses on accepting the illness and establishing an identity separate from the illness. “It is a problem I . . . . B U L L E T I N B O A R D. . face, not who I am,” he says. “I try to teach people to be specific about what they feel is lost or damaged so they can embrace and develop what is healthy and She tells it like it is. “I tell patients there’s nothing capable to be developed and to actively repair what is wrong with you. You just have a different way of damaged.” perceiving the world.” – Dr. Patricia J. Jennings, Lansdale Shake, rattle and roll. Nancy Wieman, deputy administrator of the Montgomery County Office of Mental Health, will unveil the County’s new plan for Back to Shul. In my effort to involve myself in social restructuring the County mental health system at the activities I joined a synagogue. I chose a small reform NAMI Montgomery County meeting November 16. congregation. The members like to describe themselves We’ll keep you posted. as “haimisha,” or down to earth. – Rebecca from Abington

Balancing act. As a family member it’s important to keep your own identity. Make sure you maintain your own person and don’t get lost in somebody’s life. Balance is so important. I’m taking a painting class. It’s something I’ve always wanted to do. The group depends on you to come and you support each other – not only do you paint but you become a part of that group. I make things and then I give them away – clay

5 pots, paintings on slates and boxes. Everything I create stepping up to the plate. You’re not necessarily going I give away. I have one of my pots, a little piece of me, to get a hit, but you’ll never get a hit if you’re sitting on going to El Salvador. – Linda from Fairless Hills the bench. – Bob from North Wales Emotionally starved. I was never nurtured by my “Meeting makers make it” (an AA slogan). I suffer parents. I can’t sleep at night and sometimes I call the from depression and alcoholism. I’ve been sober 30 Crisis Center because there’s no one to talk to. I had years. I attend AA meetings five times a week. There is the most amazing guy on the phone. He was giving me no possibility I could make it through life if I didn’t philosophy about suicide, negative thoughts, putting a attend meetings. And if I didn’t believe in a Higher rubber band on your wrist to stop your negative Power. I noticed that at New Directions meetings thoughts. He was the most amazing person and helped spirituality is rarely mentioned and wonder why. – me get through the night. – Susan from Hamilton, NJ Bruno from Chestnut Hill Lifetime member. One day I was so stressed out I just took my headphones and a copy of the Compass and went to the park to read it. I keep the Compass nearby. The next Richard Feynman? On TV, I saw a course I read it from cover to cover. It’s almost like a Bible. – advertised on helping people learn the basics of math. Susan from Hamilton, NJ I’m taking classes at Bucks County Community College and have failed math three times. The last time Shifting gears. I like to have some time before I start I went to class, I went once and never came back. So I preparing to get ready for work. I have to change gears. ordered the math tapes in the mail. They’re really I have to get into my “work mode.” I like to have an expensive. But this time I’ll have a better chance of hour or two in between whatever the last activity I was making it through the class. – Mike from Ambler doing – whether food shopping, going to the mall – whatever – I like to have that time in between. I think about what I’ll be doing at work. I can function at 100 The pip. Frankly, we didn’t know what to do with our percent when I give myself time to change gears. I’m a grown daughter. She was diagnosed with borderline group leader at Weight Watchers at three different personality and bipolar disorder. She’d take one locations, which are all churches, so I tell people I go medication after another. She has a 2-year-old and had to church three times a week.– Fran from Blue Bell to give him up to her husband because she couldn’t Praise the Lord. What a healing experience! I don’t take care of him. She was unreasonable and you feel heavy. I feel a burden is taken off my shoulders. I couldn’t talk to her. Three months ago she went on just rejoice. I feel like an angel floating in the air. – Abilify (ariPIPrazole). It was like a miracle. She did a Wendy from Levittown after visiting her mother’s 360-degree turn around. God willing, it should only revival church in Perkasie last. – Rona from North Wales So who are they? If I ever got depressed again, I’d Uncle Sam is watching. I’m on Social Security drive down to Maryland and see a Disability and get $580 per month. I got a small under- neuroendocronologist. Did you know there’s only 2 in the table job and someone reported me. Wouldn’t you the country? – Our Nancy know that the person who reported me doesn’t work and sits around all day making trouble for other people. Delete button. My therapist and I are working on ways I got it all straightened out, though. What I did were the to help me get on with my life. She’s always telling me following things: (1) Called my SSD lawyer who told that I’m hanging around with the wrong people, me how to handle it, and (2) Called my social security negative people who send out negative messages into caseworker who helped me out. So the motto is: hold the universe. One day I actually listened to her. I got onto all your paperwork and keep it handy in case this rid of 6 people. I feel like a new person. – Mona from ever happens to you. – Chaz from Levittown Philadelphia

No. 2 at bat. I was watching the memorial service for Debtor’s prison. I got myself into very bad financial 9/11 on TV. Everybody was standing there silently as straits. I now work with a guy from a firm in people were reading names of people that had died. Massachusetts who’s helping get me out of debt. I Life was just taken suddenly away from them. I took highly recommend him. He’s going to save me $200 that moment to reflect how lucky I am, even though per month right off the bat – with lower interest rates. I’ve got bipolar 2 and have been unemployed for 6 The company’s web site is: www.CambridgeCredit.org months and my wife and I get into fights all the time. I or www.goodPayer.com. – Murray from Blue Bell have a job interview tomorrow. I tell myself that each time you get a job interview and I’ve had lots, it’s like Hello, is Mr. or Mrs. Deming there? I don’t screen my phone calls. I like the surprise of not knowing

6 who’s on the other end. This morning a solicitor named Dimitrius called. We began chatting after I asked him if Mary Anne, who runs the group, looked especially he was Demetrius from the movie “Demetrius and the fetching in her new short hair cut. Once a teacher at an Gladiators” with Victor Mature. He said no, but we exclusive private school, as well as doing marketing for chatted anyway. What an amazing guy!!! He’s an ex- a Philadelphia museum, her illness – both bipolar and con who’d gotten his GED in prison, came out, went its kissing cousin OCD – knocked her down for years. back on the streets again, saw the error of his ways - But she was making a comeback. Though we can’t say through Christ’s intervention - went straight, earned a why, she had stopped thinking of herself as a BA in business administration and is now working on professional patient and was now volunteering at his master’s. He’s also a missionary. He tours the Abington Hospital. world playing Christian music and preaching redemption. Check out his web site: She and Kate, a former college English professor – you www.LovingChristRecords.com. Be sure to read his could actually picture her standing in front of a life story. – Ruth from Willow Grove blackboard discussing Keats – was also knocked down by her illness. She was bringing herself up slowly by working at a library job. “It’s so boring,” she said, “I’ve been getting to work late.”

BULLETIN BOARD: Special Sleep Ruth, who is very strict, gave Kate a playful tap on the Section wrist. “Don’t do anything to jeopardize your job.” She mentioned there are certain people – high achievers, Are you sleeping, are you sleeping? I’m not a good perfectionists, not to mention that psychiatrist who’d sleeper. I never travel with anybody because my sleep worked at Yale and made a serious suicide attempt - patterns are so erratic and I need the TV on all night. who go into severe depressions when they stop Sometimes I just pace. Sometimes I sit up and read. working. Ruth was one of them. “You think boredom is I’ve had this problem for centuries. You get used to it. I bad?” she exclaimed. “Wait’ll you wake up in the don’t fight it. There’s no point. If you’re not going to morning with nothing to do all day but thinking up sleep, you’re not going to sleep. – Patricia from ways to kill yourself!” Cheltenham By now, our table was filling up. Mary Anne dragged Untangling. Before I go to bed, I’m all wound up. So I over another table. You never knew who was going to sit in my chair and unwind before laying down. That show up. Or what people would talk about. The topic way I don’t have a million thoughts going through my of using ovens to dry things off came up. Mary Anne head. I sit and look through photo albums of my shared a tragic but hilarious story about a couple she grandkids or just let my thoughts drift. It still takes a and Larry go skiing with. Apparently the couple had while before I’m able to sleep. – Carolyn from gone skiing and left their mittens and their hats in the Chalfont oven to dry. (Dry-by-pilot-light). You can guess what The mother of all poor sleepers. I have the television happened. They turned on the oven and actually burned on all night and sleep on and off while watching. I down the house. don’t know if it’s an addiction or not but I look forward to watching Entertainment Tonight and Martha Other people’s stories always make us feel better. Ruth Stewart. I’ve been watching Martha a long time. She said she didn’t feel so bad now after baking her wet shoes in the oven. handles food so well. I try to remember her recipes. They’re good but not really wonderful. The “Lime Matt needed a second cup of coffee and went Melt-Aways” were the best so far. – Bernice from downstairs to buy his favorite: Starbucks. It came with Huntingdon Valley a darling cardboard wrapper so you wouldn’t burn your hands. Matt took it off – it had flaps with tiny holes...... L I F E . . . . . Everyone wanted to play with it. So he passed it around. He mentioned that his grown son, an artist, The smell of coffee could really make something astonishing with it. Unfortunately, said Matt, he and his son were not MORNINGS AT THE MALL talking.

(New Directions offers 2 morning meetings a month at “ Why don’t you send it to your son,” suggested the the Willow Grove Mall. Call 215-659-2366 if you’re ever-ingenious Mary Anne. “Put a note with it that interested in joining us in our lively conversations.) says, “Thinking of you.”

(Some names have been changed.)

7 Matt, who is very deep, paused for a moment. You could watch him thinking.

“Yes, I’ll do that, Mary Anne,” he said. “I’ll do that.” Part One: Mrs. Olson – Whatever could go wrong, “Let us know what happens,” she said. did!

(1) Mrs. Olson has suffered severe mood swings her entire life. To treat this condition, bipolar disorder, she ADA’S OUTING: POOLSIDE has had the same highly regarded psychiatrist for 12 years. In spite of his nice ways, she has misgivings about his ability to treat her: He has never been able to Bob brought his bathing suit and his dog, a basset successfully alleviate her wild mood swings. Certainly, hound named Abby. He and his wife found her at an we thought, she could be a treatment-resistant case, animal shelter. Bob, who is President of the Smart but, why, we wondered, would anyone stay with the Club, said the basset is descended from the same doctor if he wasn’t helping her? bloodhound. Abby was the hit of the party unless you count Ada with her toothpicked watermelon, To make matters worse, during the course of her cantaloupe and mouthwatering fresh pineapple. treatment, she had been on lithium. It caused irreversible kidney damage, forcing her to eventually Out on the patio Ruth sniffed the fresh pineapple and go on kidney dialysis. (See editor’s note below on said, “This is the only thing in the world I’m allergic lithium.) to. If I ever married a rabbi and he wanted to murder me, all he’d need to do is lace my soup with crushed (2) Mrs. Olson has now been on kidney dialysis for fresh pineapple. I’d be dead within three minutes and five years. She says her whole life revolves around the no one would be any the wiser.” three days a week she must go in for four-hour treatments. The quality of her life is so poor that she Speaking of murder, Ada’s son, Aaron, a Yale graduate often considers suicide. (We wondered to ourselves if who is now a law student at NYU, worked this summer perhaps some aggressive treatment with psychotropics on Death Row in San Quentin. Very nice people, he might help, in addition to supportive counseling. We said of the prisoners. also noted to ourselves that she needed a reason to stay alive.) We were planning a new program, a meeting of the minds. We’d call it “Lunch with Bob” and would invite (3) As if all this wasn’t enough, Mrs. O suffers from all these interesting people we all know. Ruth and excruciating back problems, necessitating her seeing Shelly both said they were starved for intellectual yet a third physician. stimulation. And so was Bob, since his retirement as an attorney. She asked us flat out: “What should I do?”

When we posed the question to Bob, he said he liked We told her she had a very complicated case and that the idea, but did volunteer work and took classes every we would discuss it briefly with her, while taking her day of the week. The activities were his wife’s idea to desires and her limitations into account. We would not avoid “retirement depression,” not to mention keep him tell her what to do, but we would lead her to do what out of her kitchen. she herself believed best for her.

We were sorry Bob had to decline. Quipped Shelly, The first thing we talked about was if it was “worth it” “So we’ll still have the club and call it “Lunch Without to get a consultation from another doctor to improve Bob.” her mood. Did she have the stamina required to find another doctor? In addition, she was ultra concerned about hurting her doctor’s feelings if she left him. We ASK THE COMPASS told Mrs. Olson that her suffering was the most important thing in the world, not her doctor’s feelings. The Compass receives calls from people with everyday She had an epiphany and saw this was true. She had problems and people with extraordinary ones. We’re known this all along, but by verbalizing it to someone printing two items, each embodying a number of else who understood, she was able to make her own pressing concerns in the world of mental health. decision. By now, the “fight in her” had been Details of each have been changed. reawakened.

8 and creatinine. Back in 1970 when lithium came out, Where should she find a new doctor? she asked us. there were no treatment options. Today we have many. Because of her time schedule – her whole life revolved around doctor appointments – she couldn’t drive very far. But we were certain there must be some excellent Part Two: psychopharmacologist within a 20-minute drive of where she lived. Our daughter’s in trouble: Worst case scenario

We suggested she talk to her family doctor and ask him Q: We have a terrible situation. Our 22-year-old for top-notch doctors in the area. We told her the key daughter attends college in Baltimore and has her own words to use were, “Where would you send a family apartment. She had a history of depression as a member?” teenager. We’re a close family and keep in touch several times a week by phone. Suddenly, we notice Then Mrs. Olson made a good point. She stated that her behavior is changing. She’s angry with us and she was afraid doctors would reject her because of her hangs up the phone. We get her credit card bills and difficult case. That’s true, we said. You have a very they are in the thousands of dollars. Her phone has difficult case and pose a challenge to doctors. Many been disconnected and a friend who checked on her doctors will not take you on. But, we said, some said she is no longer living there. We have bipolar doctors absolutely love challenges. disorder in the family and we are afraid she is on a manic high. We’ve been out of touch for 4 days and We told her that when she began phoning doctors she don’t know what to do. We don’t want to alienate our should expect to be turned down and expect to be daughter by bringing in the police. What do you frustrated. This attitude, we said, would lessen the suggest we do? We are also worried about how to disappointment she would feel if she was rejected by a handle her if she comes home. doctor. She liked that strategy.

We also asked her another question which she hadn’t A: Your situation is very distressing indeed. But there thought of. We were sorry we brought it up. We asked are practical things you can do to try to locate your about “coordination of care.” In other words, are each daughter and to ease your mind. First, we recommend of your 3 doctors in contact with one another about the that you keep a list of all the steps you take to locate medications each prescribe for you. (We often find this your daughter. Write down the names and phone to be the exception rather than the rule.) Perhaps her numbers of everyone you talk to. Include dates of depression had to do with poor drug interactions. phone calls. This list alone will help put a semblance of order into a chaotic situation. We would also advise We thought to ourselves that in today’s health care you not to worry about alienating your daughter. Her world – where treatment can, at times, be nothing short health and whereabouts are paramount. of abominable - that many patients have taken on the role of “health coordinator” themselves. This applies to all fields of medicine, not just psychiatry. We spoke with Tony Salvatore at Montgomery County Emergency Service (MCES) in Norristown, which is a This issue was clearly secondary to Mrs. Olson. But psychiatric crisis service. They maintain a 24-hour she was positively revved about finding a new doctor. crisis line, and they are also a hospital for psychiatric patients in crisis. Tony also took our question to Julie We also suggested that if she could squeeze in a little Peticca, MCES Crisis Department Director, and Don extra time, she might come out to one of our meetings. Kline, MCES Criminal Justice Department Director. Here are their suggestions on how to handle the situation.

 Check with the college that your daughter is Editor’s note: Regarding the use of lithium, we’re attending. The student health center and the aware of a dozen or so people who suffered kidney campus police may be able to help by determining damage after using the drug for many years. Folks on that your daughter is all right or at least relaying a long-term lithium maintenance should be aware of this message on your behalf. risk and discuss it with your doctor. Make sure you get 2 yearly blood tests: the BUN (blood urea nitrogen)  Get in touch with a mental health crisis center in Baltimore. Privacy and confidentiality policies

9 will limit what they may be able to tell you. However, if your daughter is known to them, they may be able to share your concern with her. Good luck and keep us posted!

(Note: MCES was the first agency in the country to  Despite your concerns, you should contact the provide police training programs for people with Baltimore police department. The police are often mental health problems. Under the direction of Dr. involved in mental health crises. They may take Rocio Nell and Donald Kline, MCES is the model for someone in crisis to a hospital or mental health many other police training and jail diversion center or give a referral when the situation is not as programs. MCES is open 24 hours a day. Call 610- serious. 279-6100. Visit their web site: www.mces.org.)

 You may be able to file a missing person’s report. (Her credit card receipts will have given you an idea of whether or not she is still in the Baltimore . . . J U S T F O L K S . . . area.) It will be up to the police to decide if this is a missing person situation. FAVORITE ICONOCLASTS  Should your daughter turn up at your home in MAN OF STEEL: “AIN’T I Montgomery County and you believe she needs INTERESTING?”” psychiatric treatment, do your best to convince her to get help from a mental health provider or at least see her physician. Age: 64

 If she is severely depressed, psychotic, talking Marital status: Divorced. about harming herself, or showing other similar behaviors call MCES at 610-279-6100 (24 hours a Occupation: Retired, living off pension, Social day/7 days a week). If, she is suicidal or presents Security, sales off EBay. an imminent danger to herself or to others, call 911 immediately. Previous job titles: Project manager for computer systems at General Signal Corp.; systems manager for Leeds & Northrup (33 years).  In Montgomery County many crises are resolved in the home or at the MCES crisis center. If IQ: “170 or something like that.” hospitalization is needed, an individual may be able to request a voluntary admission. Patents: 3.

Biggest obstacles to living well (1) No room to  If an individual is a danger to herself/himself expand. Ex-wife insisted he was a “hoarder” and that and/or to others, and is unable or unwilling to be he must keep his “junk” confined to approved spaces; hospitalized then an involuntary admission may be (2) numerous series of shock treatments but can’t necessary. The police, family members, or others remember how many; plus 5 involuntary commitments who directly witness the individual’s behavior may for mania and psychosis. initiate the process. Thing most proudest of: “The kids.”

 MCES helps with involuntary hospitalizations and Mood states: “Always depressed. For about 40 years. I can provide information on what is involved. guess you could say I’m dysthymic. Then in December MCES relies upon involuntary hospitalization as a I get a little relief. I become hypomanic and can enjoy last resort when there is no other way to safely life for about a month. I’m a totally different person.” help an individual experiencing a psychiatric emergency. Recent greatest pleasures: Charting of most recent hurricane on home-built computerized weather station. Also, watching eclipse of moon from back porch.

Favorite restaurant: Daddypops diner in Hatboro.

10 Favorite food: Scrapple sandwich on Kaiser roll with ketchup.

Hobbies: Hunting, collecting toy steam engines, flea Nothing goes to waste for … marketing, asking out waitresses.

Personal statement: “You never met or will meet THE QUEEN OF THRIFT anybody like me. It’s because I’m so unique. And I often laugh at things nobody else finds funny.” Ultra-modest “Cindy” who’s been in the medical profession for 25 years, lives in a condominium in Philosophy of life: “I have none.” Philadelphia. Among her many claims to fame is her low electric bill. She told us, for example, that the Defense when accused of being a hoarder: “I’m not a basic electric rate in Philly is $20. Her and her hoarder. There’s a classic definition of a hoarder and husband’s is $28. I’m not that. I can throw things out. I think hoarders can’t throw anything out. I only save stuff that I’ll be Here’s how they do it. able to use or sell. I don’t save stuff that’s useless like papers or trash.” You have to understand what appliances in your house use a lot of electricity. Top of the list are the Seating areas in house: “There are two places you can refrigerator, the air conditioner, and the clothes dryer. sit in my house – in my computer room and in my Also watch for things that get red hot such as the living room. When I know someone’s coming over I electric stove, the iron, toasters, and hair dryers. clean off one of the chairs.” Computers don’t use much electricity.

Most recent EBay coup: “I recently sold some I have a small refrigerator instead of a large one. When electronic stuff. The average person would have no I use it, I get everything out at once instead of going in idea what these things are. They were in the trash at a and out. flea market, and I sold them for over $400 apiece. The people that threw them out had no idea what they I always turn the lights off when I’m not in the room. were.” It’s also good to know that fluorescent bulbs use lots less electricity than regular light bulbs. Wind behind his wings: “My mother.” Home repairs – I do a lot of repairs on things, rather How he perpetuates her legacy: By planting than going out and buying new things. I have a pair of rosebushes and iris. rubber- soled hiking boots that had a hole in the soul. I plugged it up with something like household caulk, a Where he learned his work ethic: “The week after material that would do the job but might not my father died, my mother started working as a necessarily have been sold for that purpose. cleaning lady. There were 8 kids to feed.” My husband has dress pants. When he carries his Biggest disappointment: Received full scholarship to briefcase, it rubs on the side of his pants. The fabric a Jesuit college. When dean of admissions learned he turns a lighter shade on that side. In order to extend the was diagnosed with mental illness, scholarship was life of the pants, I get out my crayons and my pastels to withdrawn, in spite of intervention by mother and the restore the color, so he won’t have to throw the pants parish priest. away as quickly.

Greatest simple pleasure: A bowl of hot soup. I reuse plastic bags. They can be re-used by washing them with hot soapy water. I also reuse my dental floss, An aside from the editor: It goes without saying, that which can also be rinsed in hot soapy water. this extraordinarily gifted man – like many others – could have gone on to true greatness but for the If I really have to throw out a piece of clothing, I save severity of his disease. All the more reason for us to the thread from the fabric so I can reuse it. I rip it out in send NARSAD Research a check to fund research into such a way so that I have long pieces of thread, which mental illness. Do it now while it’s on your mind: can be wound around a spool. I never buy thread. NARSAD, 60 Cutter Mill Road, Great Neck, NY 11020.

11 I tend to recycle just about everything. Styrofoam trays founded). In addition, he’s founder of the “Pinks & from the supermarket have a million and one uses. So Blues,” a peer-run discussion/support group for do old mouse pads. bisexual, gay, lesbian and transgendered individuals dealing with mental illness. He is also the newly There’s a dumpster at the condo where I live. I’ve elected Secretary for the DBSA PA organization. As gotten quite a few things: discarded window shades, you will read, Mark is the personification of curtain rods, fluorescent light bulbs. I’ve also gotten “survivorship with a sense of humor.” porch furniture, plant potters, house plants. I got a beautiful dying hibiscus out of the trash that just Dear Fabulous Folks, Friends & Family: needed a little TLC and a wonderful fan that was broken. It was just a matter of opening it up and putting With pride I share my 15th Anniversary of testing in a paper clip. HIV-positive. Yes, 15 years since the test result I'll never forget and have grown to live with. That day was * as bizarre as any other in the world of advocacy. I was spatting with the President of the American Psychiatric Mr. Jack Russell. He sits there all day and basks in the Association for not sun. Sometimes he’ll just start barking at people for no including a consumer in a Mental Illness Awareness reason at all. A lot depends on how fast the people Week Lecture. They later relented and allowed me to walk. If the people are walking slow, 9 times out of 10 introduce a featured speaker, but instead I afforded the he won’t bark. One time when I was walking him a opportunity to first give an awesome consumer speech. woman got out of her car and started petting him. He’s almost human sometimes. You know how people yawn Then off to the PARF (PA Association of Rehab and make different expressions when they yawn? He Facilities) conference awards presentation to receive has those same expressions, too. their advocacy award. I remember my Aunt DoDo and Mary Hurtig were there as I hid the tears. Linda Flores and I went to an aerobics class and I later went to an ActionAIDS- sponsored HIV support group at St. Mark's church. A day I'll never forget no matter how many shock treatments I endured later.

A defining moment being HIV-positive was at Rite Aid in the Q-tip section. I couldn't decide between the box of 50 or 300. Being cheap, I didn't think I'd live to use a box of 300 during a time when friends were passing rapidly. It was at that moment that I chose to live long and well and purchase the box of 300 Q-tips. Been buying in bulk ever since, but no longer at Rite Aid!

I would be honored if you would consider personal or agency membership to the organization I am proud to be called Founding President: The PA Mental Health Consumers' Association. PMHCA is a statewide membership organization representative of the individual and collective expression of people who have recovered or are recovering from mental illness. This guy means business Our purpose is to improve the quality of lives through advocacy, education and the elimination of stigma and discrimination. My roots in the mental health consumer/survivor movement were the turning point in LETTER FROM MARK DAVIS my recovery in 1985, thanks to being the first consumer “hire” at MHASP by Joe Rogers. Mark Davis, a famous unstoppable advocate on the Philadelphia mental health scene, wears many hats. To join PMHCA, visit the following web site: Take a deep breath and read his imposing occupation: http://www.pmhca.org/pages/membership.html Behavioral Health Science Special Needs Analyst at Philadelphia Office of Mental Health c/o Pennsylvania Mental Health Consumers Association (which he

12 Cheers to each of you, both living and passed, who experience of dealing with Americans because she have played a significant role in helping to recover to worked in an import company. She’d spoken to live long and well despite the odds. Americans on the phone. She enjoyed speaking with them but had a lot of misconceptions about Americans. Love Always, I’d keep correcting her images.

The Pinks & Blues meets every Wednesday at 6:30 PM She had talked to two other men and I stood out. Some at the Church of St. Luke and the Epiphany, 330 S. women fear the abuse stories they hear about American 13th St., Philly. For info, contact Mark at 215-546- men. 0300, ext. 3301 (office) or 215-627-0424 (home) or email: [email protected]. We entered into an email correspondence. You’re sending emails back and forth and finally, you want to make phone contact and hear the voice. The first phone call was really touching… touching to hear her speak English. She profusely apologized for her English. But Searching the World I could understand the feeling she was putting into the words. LOVE AND MARRIAGE After the initial phone call, we began speaking once or twice a week. (You find a cheap long distance service.) Joe Bunting’s mission was to find a bride. Head of the DBSA support group in Delaware County, we know We talked about her motivation for getting married Joe to be a consummate man of action and and moving to America. There is always a chance the intelligence. As you’ll read, he lets nothing, not even woman is “using” you to come to our country. But after his illness, stop him from living the kind of life he we began chatting, there was never a doubt she was desires. A couple of years ago, Joe, a man with a deep interested in me for who I was. She was an work ethic, found that his meds were making him adventuresome woman, she liked to travel. The drowsy so he could no longer function at top capacity prospect of moving to America was very scary, but she at work. He and his doctor lowered the dose. knew she’d met the proper individual and the proper man. He discovered that, “the more my quality of life I was going to fly there to see her and get final improved the less medication I needed. confirmation. The timing was incredibly perfect now What Joe most desired in life was a wife. So it wasn’t and throughout the whole process. I attribute that to surprising when he told us he’d found a wonderful God’s intervention. There was a lot of prayer going on woman to marry, and that the marriage is nothing here. short of sublime. Here is his surprising and inspiring story. We spent 10 days together. I stayed in a hotel. The culture is entirely different than ours. You don’t hold I learned about a web site for Chinese women who hands in public, no signs of affection in public. She want to marry foreigners. I went to the site. It did cross was always dressed properly. In that initial meeting I my mind that women might be using the marriage as a said to myself, let me look into her eyes and see if she pretext for escaping from China and coming to is being true and honest with me. We had talked about America. But my fears were quickly dispelled. everything under the sun on the phone. Now I just wanted to see if everything was as I perceived it. It was On the web site, every woman lists her profile. a ten-day visit and I knew by about the third day I was When I first saw Liyan’s picture on the web, there was going to marry her. I asked her to marry me. something about her cute little face that attracted me. I was courting about 5 different women by email but She was quite shocked because she expected me to go Liyan (pronounced “lee-ANN”) stood out. Her home and think about it. But I was sure. biographical profile said she spoke English, which was a critical prerequisite for me. From her profile, you could see that this was a kind woman. She didn’t I remember the moment I asked her. It was in the foresee herself getting married to a Chinese man. She hotel room. There was a deductive process I had to go was 32. She was from the Hunan province in the through before I’d take such a drastic step. This is such People’s Republic of China, and moved to a an unusual move. There was also a stigma attached to technological city north of Hong Kong after receiving this, marrying a foreigner through an Internet forum. her bachelor’s degree. She had the intelligence and Here I’m walking into another stigma.

13 ago because of the need to work. Right now I’m The next major hurdle was to tell her about my illness. working as a substitute teacher in Philadelphia. I have Was she going to accept the illness? I wanted to see her to get up at 5 in the morning to be at work and you reaction. It was very hard for her to understand it. I never know until the last minute if they’ll call you or described it to her as ups and downs… being very not. It’s horrible, but what can you do? down, very sad. It’s important for others with mental illness not to give I think it took her overnight to think about. She didn’t up no matter how much rejection we get. We have to understand it. She did not see this in the way I acted keep reaching for our goals and getting support. If I and spoke. So, she thought, what was I talking about? stopped trying, I’d be on Social Security now and lying in bed with a bottle of wine.

I’ve had nine years of stability which made me take this risk of marrying. But as time went on, the risk Editor’s note: It’s extremely important for threshold began to decrease and I knew what I was unemployed people with bipolar disorder or depression doing was right. to realize the importance of returning to the work force ASAP, lest “unemployment depression” set in. The necessity of a “routine” – which we achieve through She said yes. The cultural adjustment was critical on regular work hours - cannot be overstated, especially both our parts. Our culture is just so free and so open. when one’s body has gotten used to the rhythms of the There were a lot of adjustments on my part. There’s a nine-to-five world. respect you have to have for the Chinese female. If you don’t know these expectations, then you’re going to * insult the person. There were little things I never knew about… and there were a lot of apologies on my part. Wawa, Dunkin’ Donuts. I gave some psychology department colleagues a ride in my car. I had napkins She’s committed to me, a lifelong commitment. all over the place. One asked me, "Why do you have so There’s no question about that. For myself, I’ve got many napkins?" I told him a friend once told me that someone to talk to and share my feelings with, since I eat in fast food places, I should never have to someone who truly loves me. It’s one thing to be alone buy paper towels again. Just take out napkins. So, I and another to be lonely. I was comfortable with take out napkins whenever I eat in fast food places. I aloneness. But I did not like feeling lonely. err on the side of taking too many rather than too few. The name of the friend who told me: Ruth Deming What I needed was a partner to complete my life. Liyan is my partner.

NOTES FROM A THERAPIST: Heigh ho, heigh ho “Savor the Day” or “Where is this Canyon anyway?”

“OUR NANCY” by Billie Lee Orenbuch, LCSW When we last heard from Our Nancy, she had come through her killer 18-month depression and was now Recently I've been taking a course with Marty trying to find a job. Seligman, PhD, of the University of PA in which I've been learning how to understand, become and then I’ve sent out 125 resumes. I even found certain jobs teach others about "authentic happiness." This is the that I had the perfect credentials for. I’d get letters of kind of happiness you feel all the way down to your rejection that said they found people with even better bones… for a moment, or an hour, or a month, but you credentials. know what it is.

I need to work. I don’t want to lose my house because We've had assignments in which we had to argue with it’s beautiful. The thought of losing my condo is like ourselves and then talk to each other about it. We've the thought of losing my whole world. I’m now being had assignments in which we had to: write formal open to jobs that I wasn’t open to six or seven months letters of apology, or, write formal letters of gratitude.

14 We also had assignments in which we had to present of the scenery were richer that day and the curves letters of gratitude after we apologized. Primarily, smoother and softer. these were deeply thought out, gut-wrenching tasks, as opposed to something that could give us pleasure. We drove through a dozen nineteenth century towns that we swore we'd seen before. We spoke with several Finally, last week, we were given an assignment to farmers selling produce. Their faces were lined with "Savor the Day." It’s been years since my husband and the sun. Their produce was fresh, crisp, bright in color I have taken the time to drive around a new area and and appealing. We found many different kinds of fresh, explore it together. It was an activity that never failed homegrown or homemade fresh produce: fresh goat to give us pleasure in the past. I looked at the map and cheese, honey, maple syrup, pepper jelly, carrots, remembered that we had never seen the Grand Canyon tomatoes, cucumbers, corn-on-the-cob, and green of Pennsylvania. I checked the internet and found the peppers. We’re still savoring that day. distance and a bed and breakfast (4 ½ hour trip). What I noticed was that it took quite a while to let We made the necessary arrangements: Finding a down from the rush and bustle and worry and just relax caretaker for my adult daughter’s new puppydog, her and have fun and savor. It required being there for the two cats, and my cat. Then we had to drive my second day. We seldom allow ourselves that kind of daughter and her husband to the airport so they could time. This was wonderful. I felt truly refreshed on go to her inlaw’s. We were free to leave after that. Monday.

Driving up was much more difficult and less One of the things I learned from the exercise is that life pleasurable than I expected. We drove on the needs to be savored as we go along. It was a problem Interstate. We were tired and grumpy. The weather that it took such a long time to get into the mood to was rainy off and on. We finally arrived at the tourist enjoy myself. There isn’t any reason not to be able to office, only to discover it had closed fifteen minutes decide to have fun or decide to deepen our pleasure earlier. We drove to the “grand canyon” and saw when we choose to, not when the stars are right or beautiful tree-covered hills and a long valley with a someone else gives us permission. I have to make it all river running through it. The hills were misted over. right for myself and then I have to keep making that choice. We drove to our bed and breakfast. That turned out to be quite thrilling because the people that are still in the Billie Lee Orenbuch is manager of Psychosocial Skills process of building it have poured their hearts and at Psychological Services & Human Development souls into it. It’s brand new and it’s quite charming. Center in Fort Washington, PA. She can be reached at Not that this is a plug, but the place is called, “The 215-884-0093 Woods,” and it's near the border of PA and NY. The buildings are beautiful, the rooms feel like they are part of an upper middle class home. Behind the buildings are formal gardens, and a pond and gazebo. The bed is . . . H E A L I N G A R T S . . . more comfortable than the one I normally sleep on.

When we got up for breakfast, we had slept well. Breakfast was delicious, overlooking the garden. We ASK DR. BERRETTINI were much more cheerful, meandering through the scenic route back to our house near Philadelphia. My husband, who's a history buff, thought we should check by Wade Berrettini, MD, PhD out Elmira, because he believed the founder of the University of Pennsylvania Mormon Church, Joseph Smith, came from that city. Unfortunately, we discovered, it was Mark Twain's study and gravesite that are there, but nothing about Q: I'm aware of about a dozen people who have been Joseph Smith. For other history buffs or for offended taking lithium for a number of years and are now Mormons, it was Palmyra, NY. After the side trip to suffering kidney damage. Is this becoming common for Elmira and a visit to Mark Twain's grave site, we people on long-term lithium maintenance? followed the Susquehanna River much of the way. Waterways are my favorite way to travel. All the colors A: A small fraction of individuals seem to develop lithium-related decreases in kidney function after

15 several decades of treatment. This sometimes requires emotionally devastated by this I’m seeing a psychiatrist that they stop the lithium. This decline in kidney myself and am on Ativan. Is it my fault she has bipolar function is poorly understood. There is no way to disorder? I keep asking myself what did I do wrong? predict who will experience this. For this reason it is Question: Should I continue blaming myself for the recommended that persons on lithium have annual, problem? What part does heredity play in bipolar inexpensive blood tests of kidney function. Be sure to disorder and what part does environment play? discuss this with your doctor. A: The fraction of risk for bipolar disorder attributable to genetics (the heritability) has been estimated to be Q: My wife and I have a 35-year-old son who is about 80 percent. We do not understand the type of married and has two children. He recently told the environmental influence which interacts with the family he was gay and has been meeting with his lover genetic susceptibility to produce the disorder. A parent for many years. This, as you can imagine, came as should not blame him/herself for the development of quite a shock to my wife and me. We wonder if there's bipolar disorder in a child or any other relative. a homosexual gene. Question: Is there a homosexual gene? *

A: No, there is no homosexual gene. As with other Dr. Berrettini is a world authority on the genetics of complex human characteristics, sexual orientation is a bipolar disorder. He is the Karl E. Rickels Professor of function of interaction among genes and environment. Psychiatry, and Director, Center for Neurobiology and Thus, multiple genes and environmental influences Behavior, at the University of Pennsylvania School of shape sexual orientation. Medicine. For information about his genetics study utilizing 2 siblings with bipolar disorder, call 215-898- 0092. For information about research studies at Penn, Q: Several years ago, I played tennis and volleyball. see www. www.uphs.upenn.edu/cnb) Then I had my first episode of mania, including a psychotic break. In looking back, I remember that a couple of months before the break, I lost my ability to play sports. My hand couldn’t connect up with the ball. A friend of mine, who's a nurse, said it was due to a flaw in my central nervous system. This occurred before my psychotic break. Question: Do you think the two of them – my lack of motor coordination and my ensuing psychosis - are linked?

A: There is no evidence that a deterioration in physical coordination precedes the onset of psychosis.

Q: My mother and I are both artists and think we're quite original. This got me to thinking about originality. I read somewhere that people and chimpanzees share a lot of common DNA. Question: Please clarify the people and chimpanzee DNA percentages. Also, what percentage of DNA do all human beings possess in common and what percentage are unique to the individual?

A: Chimp DNA is approximately 99 percent identical to human DNA. Although there are abundant diversities in human DNA, in general, people share about 90 percent of DNA in common. Only about 10 percent is specific to one ethnic group or another.

Q: My 18-year-old daughter was diagnosed with bipolar disorder a year ago. I’m a teacher and am so

16 Just a coincidence? Compass editor, above, was driving down the back streets in her neighborhood "They were able to communicate with their bodies," when whom should she meet but Cindy Smith (not says Levicoff. "Lacy uses her body and her soul to shown) former staff photographer for the Intelligencer communicate. It's almost as if the patient and the pet newspaper. Cindy, now a dog breeder, was walking were breathing as one." three of her dogs, including “Tish,” (shown above) who is one of the therapy dogs in Pet therapy grew out of an idea in the mid-1980s. Abington Memorial Hospital’s pet therapy program. There had been anecdotal evidence that pets brought a Story below. new sense of health and vitality to a person's life. International organizations were founded, espousing the virtue of pets as part of a person's overall wellness. Scientifically proven Studies were completed that indeed proved the anecdotal evidence to be true: people with pets experienced lower blood pressure, better response to PET THERAPY: Cuddle Up medication, and increased socialization.

Judi Levicoff has a philosophy that for true healing to Abington's pet therapy program was founded by take place, man and nature must come together. After visiting nurse Marilyn Harris. "A visionary" is how all, she says, we are one and the same. And that Levicoff describes her, a woman energized to make her includes dogs and butterflies and even goldfish vision a reality within the accepting walls of the swimming in calming aquariums. Levicoff has hospital. Harris and Levicoff worked side by side. "It witnessed the wonder of this healing for the 10 years evolved so that I'm now the director," she says. she's been director of Abington Memorial Hospital's Animal Assisted Therapy Program - "pet therapy" for Twenty-five volunteers donate themselves and their short. dogs to the program. "The individuals and their dogs work as a team. It takes a special kind of person to Just watch the way people react when one of the volunteer with their dog." department's beagles or golden retrievers is brought into the hospital by its owner. "The pets have a unique As director, Levicoff has led the center in a surprising impact on the whole hospital,” says Levicoff. “They new direction. She worked with the University of bring everybody together, from the president on down Kansas, which hosts a program called “Monarch to the staff and the patients." Watch.” People throughout North America track the migration of monarch butterflies that migrate to The dogs are regularly brought to several adult and Mexico. Butterflies are tagged so scientists can follow pediatric units, including the psychiatric. their route. The program, says Levicoff, has many different levels. "I had an experience that taught me Only recently, a patient lay still in bed, her face you could work with butterflies and have a relationship immobile, arms tucked under the covers. Levicoff with them." brought in her own pet, a cockapoo named Lacy. (Levicoff, as well as all volunteers, have been trained She developed a program at Abington in which and certified to practice pet therapy.) butterflies are nurtured from their cocoon stage until their emergence as butterflies. She uses this program “ Each animal behaves differently in each situation,” with children in Abington's Safe Harbor program, a says Levicoff. "The dog seems to know what needs to group for grieving children. "You facilitate a be done." connection between the children and the butterflies. There's a sense of familiarity between them." The Levicoff asked the unresponsive patient if she could children, many of whom have lost a parent, watch the place Lacy on the woman's bed. stages of growth until the butterflies are ready to be set free and fly off on their own. "When the time comes to She carefully placed her cockapoo on the ill woman's release them, it's as if the butterflies know, and they bed. And through the mysterious process of "nonverbal don't fly away right away." They linger, as if saying communication" the dog knew just what to do. She goodbye. moved around the bed and snuggled close to the woman. "Then she planted a kiss on her shoulder." You Butterfly gardens are now a thing to look for at the could see the patient come out of her malaise and hospital - in the pediatric department, and at the front slowly come back to life. She even smiled, the first desk in the lobby. Levicoff even knows of dentists who time in a week. plant butterfly gardens so patients can look outside

17 beyond the dental chair to the flitting butterflies outdoors. The derivation of “health” connotes wholeness, balance, and resilience. The capacity for the body to Note: Abington Memorial Hospital recently won an heal and repair itself can be seen all the way up the award honoring the hospital’s leadership and ladder: DNA, cells, organs, and organ systems. innovation in patient care quality, safety and Integrative medicine unites a conventional approach commitment, one of 5,000 hospitals eligible to apply. with healing concepts – it goes beyond treatment of disease.

One of the problems with conventional medicine is the dichotomy between the doctor and patient. Too often, the patient is just a passive receptacle that gets treated by a doctor whose role is to cure through intervention. A more integrated approach focuses on empowerment. The challenge for both the doctor and patient is to join forces and proactively promote healing.

Q: What is the “mind-body connection”?

JG: The Western convention is to define the body as everything up to the head, and the brain is referred to as the mind. But, in a sense, the mind is everywhere. There are neuroreceptors and neurotransmitters throughout our bodies. So the distinction between mind and body is a difficult call. Physician author Andrew Weil refers to our bodies as physical hardware through which we can run different software. One Dr. Jack Gomberg of Project Transition fascinating example of this comes from research with people who are viewed as having multiple MEDS ARE NOT ENOUGH: THE personalities. Each personality, or “alter,” can have unique physiological allergies. This is an example of MIND BODY CONNECTION the same hardware hosting differing software.

An interview with Jack Gomberg, MD Q: What is the role of medicine in psychiatry? Project Transition by Scott Johnston JG: Conventional psychiatry is my mainstay. Many medications utilize the mind/body connection in that Dr. Jack Gomberg is a psychiatrist and Fellow of the they interact with neuroreceptors to help normalize American Psychiatric Association. In addition to deficient neurotransmitters. The recently developed serving as medical director at Project Transition’s drugs are more selective in their action... the aim is to Chestnut Hill program site, Dr. Gomberg maintains a get efficacy while minimizing side effects. The newer private practice in Spring House, PA. He can be medications are designed to regulate naturally existing reached at 215-628-8585 or email: substances in the mind/body. Nothing is perfect, and [email protected]. side effects still occur. While medicine’s role in correcting an imbalance may be necessary, it is often Project Transition maintains 2 residential facilities for insufficient because it is just one piece of the puzzle. people with mental illness, one in Chestnut Hill, the There are many factors that support optimal health: other in Warrington. physical, cognitive-emotional, relational, and spiritual.

Q: What are the pros and cons of traditional Western Q: When faced with complex emotional challenges, medicine? we tend to embrace one solution...

JG: Conventional Western medicine focuses on JG: Yes… taking medication can delude us into pathology, disease, and treatment. While this thinking, “Oh, this is the answer.” Too much faith and approach has been highly effective, the training that power are poured into one thing. But any “one thing” most physicians receive doesn’t really emphasize is rarely enough. Multiple elements need to be optimal health. activated in order for sustained healing to occur.

18 Q: What are the elements of healing? Is the medical field acknowledging them? KAY JAMISON: Iron discipline with JG: The negative side effects of weight gain and blueberries on the side diabetes associated with Clozaril and Zyprexa have fostered a greater awareness of health risks like the She’s beautiful, she’s brilliant, she writes books, Metabolic Syndrome. Fortunately, this has resulted in produces TV shows. She won the MacArthur “Genius a greater emphasis on health induction through lifestyle Award” and is the most influential person in the world modification. At Project Transition, we developed a of bipolar disorder. You may own her books. “The program called NEST. It augments other therapies and Unquiet Mind” is a masterpiece of the bipolar journey, consists of activities that promote nutrition, exercise, while “Manic Depressive Illness,” which she co- and stress reduction training. authored with Dr. Frederick Goodwin, is the definitive text on the disorder. Her bravery in “coming out” Regular exercise helps everything. Research has publicly a few years ago – she’s got manic depressive documented the benefits of cardio-vascular and illness - revealed the risks and complexity in self- anaerobic exercise. It can alleviate depression, and it disclosure. can temper mania by calming racing thoughts and anxiety. But if you’re in a manic storm, you may be Kay Jamison, PhD, is professor of psychiatry at Johns tempted to over-exercise, which is not healthy. Hopkins University. She was keynote speaker at the Nutrition is important, too. For example, in addition to national DBSA conference in August. In a reporting eating right, I also take some nutritional supplements to coup, John McNamany of McMan’s Depression and ensure proper enzyme and immune system functioning. Bipolar Weekly (Aug. 23), spoke with her. Here are Another element of healing relates to relaxation and highlights from both her talk and his personal meditative techniques – daily meditative breath work is interview. very effective. What Kay Jamison wants you to know: The powerful effects of positive relationships cannot be overemphasized. We are social beings - our - The importance of sleep, which she described as the perceptions, thoughts, and feelings are largely guided “underlying pathology of illness.” Her late husband by relationships. used to remind her to get her sleep, frequently phoning Other spokes of the wheel include fun and relaxation… her when she was on the road. She would tell him “he playing with a pet and a walk in the woods are great was worth 600 mgs of lithium to me.” stress busters. Spirituality is yet another aspect that contributes to optimal mind/body health. Anything that - Personal care: As for diet, writes McMan, two words helps raise one’s spirits can be included in this realm. apply - “Bear Diet” - lots of fish, lots of blueberries. Reading and journaling also important. Q: It can be hard to modify lifestyle, especially when depression is heavy… - Badger your doctor. “Badger, badger, badger” with questions, and on how to get your meds right. JG: Absolutely -- it requires mobilization, which depression can inhibit. Sometimes medicine can help - A passage from William James, in his “Varieties of the person get to the place where lifestyle changes are Religious Experience,” “changed her life”: within reach. Family members and friends can provide vital motivational support, too. The bottom line, “ Whilst in this state of philosophic pessimism and though, is that optimal health requires effort and general depression of spirits about my prospects, I practice. To get the dividends, you have to invest. went one evening into a dressing-room in the twilight… when suddenly there fell upon me without * any warning, just as if it came out of the darkness, a horrible fear of my own existence…” In the raw. The Upper West side menu was incomprehensible to me, but I wasn't going to let on. In In a similar vein, McMan quotes another passage from a confident voice, I ordered beef tartare. Imagine my the great poet John Berryman. surprise when the waiter brought me a large china plate with greens surrounding a scoop of raw beef “I do strongly feel that among the greatest pieces of covered with a raw egg. One bite was all I could luck for high achievement is ordeal… The artist is stomach. extremely lucky who is presented with the worst

19 possible ordeal which will not actually kill him. At that was – a computer programmer who never missed a point, he’s in business.” Berryman died at age 58 after deadline – it enabled him to live a decent enough jumping off a bridge. quality of life.

- Jamison also expressed that rather than leading a His success with Clozaril – he was on it for 8 years - “stunningly boring life” she prefers “tumultuousness continued despite his increasing unhappiness about coupled to iron discipline.” getting his blood drawn for lab work. “I felt tethered and confined,” he said. Finding a “good vein” became McMan noted in his interview that Jamison is at work more and more difficult. Finally, this became such a on yet another book. The theme and title, this time, is painful reality that he insisted on switching to another the wonderful word, “Exuberance.” (Read a selection drug. He was fully aware of the risks of switching from her chapter on John Muir and Theodore Roosevelt from something that had kept him hospital-free and the on www.McManWeb.com.) possibility of failing on a new drug. He reassured himself that many new drugs had been on the market since the introduction of Clozaril.

He discussed the situation with his wife and psychiatrist. Both were fiercely opposed to switching meds. After all, why shake things up instead of OUR FAVORITE PHARMACISTS learning to endure the necessary blood work?

GOING OFF CLOZARIL: A BAD Burt was adamant, insisting that in order to live a RISK? quality life, he could no longer endure the needle sticks. His doctor very reluctantly put him on a new A talk with Joel Shuster, PharmD, BCPP drug. It didn’t work. Nor have any subsequent drugs, including the new Abilify which caused severe voice Temple University activity.

This is a story that brings up major issues for patients (Compass update: Miraculously, after four months of and families alike. Details have been changed. experimenting, the proper combination was found: Seroquel, Risperdal and Trileptal.) “ Burt” is a Clozaril success story. As we know, Clozaril (clozapine) was the first of the new generation The bottom line is that an individual has the right to of antipsychotics (the “atypicals”) - for people with make choices, even if they do not pay off. schizophrenia and schizoaffective disorder - and is considered the “gold standard” that other atypicals are We asked Dr. Shuster - he runs a large Clozaril clinic measured by: improved side effect profile as well and his patients call him “Joel” - some questions about excellent results with both (1) “positive symptoms” Burt’s predicament. First off, he told us that he always (delusions, hallucinations, voices) and (2) negative uses the generic name of the drug with his patients: symptoms (inability to feel emotions, social “It’s important for all patients to know the trade name withdrawal). and generic names of their medications. As a medication safety expert, I know that this knowledge The downside of the drug is the necessity of having helps to prevent errors.” blood drawn every 2 weeks to see if the patient has developed a rare condition - agranulocytosis - that 1 - What are the chances of someone successfully decreases white blood cell count, thus lessening the switching from clozapine to another drug? body’s ability to defend itself from disease. This condition occurs in 1 percent or less of those on There is not a great deal of good data to answer this Clozaril. The white blood cell count must be measured question. If clozapine is being used today, a patient has weekly for the first six months, then bi-weekly usually failed on many other medications. And if afterwards. clozapine “is working,” there has to be a fair amount of risk to take someone off the medication that is working. For Burt, Clozaril was the drug he and his family had been searching for. While it certainly didn’t remove all 2 - Are there any drugs in particular that have been of his symptoms nor return him to the person he once found helpful post-clozapine?

20 the Board of Trustees of the Institute for Safe None that I know about. Of course, with each new Medication Practices in Huntingdon Valley, PA. He is drug that is on the market, there is a chance that the a certified psychiatric pharmacy specialist. new agent may help. * 3 - How long do these drugs take to work? King of the cheapskates. Bill, a Temple professor, We always say that the best effect of antipsychotic was mad. They had refused to serve him a child's meal drug therapy takes about 6-8 weeks. We often see a at Oak Lane Diner. He wanted it for himself. "What lessening of symptoms earlier in the treatment. difference does it make who orders it or who eats it?" he asked. He thought of a way around this: to order it 4 - Do you think Abilify is a good choice? “to go.” You could, theoretically, have a child at home, waiting for the food. Abilify is the newest drug on the market. It may have a slightly different mechanism of action compared to the other "atypical" or "newer" agents.

5 – Do you see much resistance to the blood draws in your clinic? MOOD CHARTING My patients have gotten used to the bi-weekly blood “How to Help Your Doctor Give you tests. Many have been doing this for more than 10 the Best Medicine at the Best Dose” years. A couple of our people always hate the blood draw, but they keep doing it! by LARRY DI BELLO, RPH Friends (Hospital) Resource Center 6 - Does such frequent blood drawing pose a danger to one’s veins? Imagine trying to get to a place you’ve never been, There is no danger to the veins, although occasionally from a place that keeps changing all the time. Without the phlebotomist (lab tech who draws the blood) has to a map. find a new site on the arm. This is the same thing as going to your doctor’s office 7 - We’ve heard that in Europe the blood drawing is for medication without either you or the doctor being much less frequent Do you think a person’s blood prepared. needs to be drawn as often as every 2 weeks? You need to be prepared. First, think about yourself and what you bring to the doctor’s office when you are In Europe, the blood tests are now done once a month. not prepared: Can you remember exactly how you felt It is my understanding that a similar proposal is being two or three days before? Can you remember, for looked at in this country. example: “Was I anxious or depressed?” – “Was my thinking clear?” – “Was I feeling paranoid?” “Did I 8 – Burt is currently in the hospital trying different sleep well?” - “Did I experience physical pain?” – medications. Do you think there's hope that in time he “Was my stomach upset?” will come around? A person can’t really remember exactly how they were I believe that there is always hope. But a well-known feeling, even a couple of days before the doctor’s visit. fact about schizophrenia is that the illness is harder to It’s important to document how you felt between treat with each psychotic episode. doctor visits.

Let’s take a look at it from the perspective of your Dr. Joel Shuster is a professor of clinical pharmacy at doctor. Temple University School of Pharmacy. He administers a large outpatient Clozaril clinic at EPPI You walk into his or her office and sit down. The (Eastern PA Psychiatric Institute), sister hospital to doctor asks you why you are there. You tell the doctor MCP (Medical College of PA). He heads the generally how you’ve been feeling and generally what “Communication Skills” course taught to all fourth- you think is wrong with you. You then relate the year students and the elective course “Medication symptoms you’ve had for the past couple of days with Safety” at TU School of Pharmacy. He is a member of

21 a vague idea of the symptoms you’ve had in between compromised, particularly my memory. Is this common visits. for people under a lot of stress.

From this kind of sketchy information, your doctor has Dr. Perri: Absolutely! Stress can impact on cognition to make a great number of assumptions. The in a myriad of ways. The first one that comes to my medication can only be as finely tuned as the mind is attention. When you’re under a lot of stress, it information you provide him with. becomes much more difficult to focus.

When you consider that every person responds slightly It happens to all of us, even those with no psychiatric differently to every medication, you are the only person diagnosis. For example, when you’re extremely that can provide the doctor the information on what the fatigued and need to read something technical or medication is doing to you. Most doctors have an difficult to understand, stress will impact your ability to excellent idea of how the medication works for the concentrate. majority of patients from the reams of clinical information they have. BUT the information they really In other words, if you’re trying to focus on a need is what the medication is doing specifically to “cognitively complex” activity such as attending to an you. advanced lecture or reading a journal article, you’re So, make an investment of one or two minutes at night going to need to sustain your attention for an extended before going to bed. It will go a long way to period of time. Your stress will detract from your accomplishing these goals. Two short minutes is all it ability to maintain that necessary focus. takes to keep a great Mood Chart. Mood charts are available from any DBSA chapter, from the Family Memory is also impacted by stress. This can happen Resource Center at Friends Hospital (215-831-4894), indirectly as well, again, because of the lack of from the internet at www.bipolar.com or call me at attention. When we need to memorize something, 610-543-2966 and I’ll send you charts - and even teach particularly if it’s complicated, we need to be paying you how to use them! full attention to it.

Larry DiBello is a retired pharmacist and is “Ask the On the other hand, we may have memorized something Pharmacist” at Friends Resource Center. He is a but when we go to retrieve it, we may have difficulty recipient of several awards including the Jonathan accessing what we know that “we already know” Roberts Award, named for the father of Hospital (word-finding problems). We can see there is a real Pharmacy Practice in the U.S. Call Larry with your interplay here with stress. And certainly there is a great questions at 610-543-2966. He answers!!! amount of frustration that occurs.

Our man in neuropsychology We can see the possible ramifications for people with mood disorders – as well as “normal” people - if we look at the extreme case of a schizophrenic brain. We COGNITION AND STRESS see decreased activity in the prefrontal cortex, which is thought to be a seat of executive function (planning and by Gregory D. Perri, PsyD organizing ability, shifting sets, monitoring behavior, that sort of thing). By looking at this type of brain, we see how intensely connected stress is with the level of Cognition refers to thinking skills: the intellectual cognitive and behavioral functioning. Again, we can skills that allow you to perceive, acquire, understand probably see some ramifications for the normal brain as and respond to information. This includes the abilities well. to pay attention, remember, process information and solve problems, organize and reorganize information, Dr. Perri is a post-doctoral fellow in neuropsychology communicate, and act upon information to allow you to at Widener University. He did his dissertation on function in your environment. (from Medalia and “Analysis of Errors Committed by Traumatically Brain Revheim). Injured Patients” on several psychological tests. Question: I’ve been looking for a job for nearly six months. My wife and I argue all the time and, as if * that’s not bad enough, we’re putting on an addition to our house. Needless to say, I’m stressed to the max. It also seems that my cognitive abilities are

22 Even over pancakes. Two therapists went out for lunch steps of the cafeteria in junior high school to a pancake house in Bensalem. By the end of their along with some of my classmates. Suddenly I saw this dining experience, they knew all about the waiter’s one boy had three legs. All of the legs looked real, in problems – he was from Morocco, felt lonely and was full color and 3-dimensional. They moved a little, all unsure about local customs. The therapists gave him very lifelike. It seemed odd to me that he had three free advice, saving the waiter hundreds of dollars. legs, but they all seemed real. Then one leg faded (Therapy, said the waiter, is taboo in Morocco.. away, and he returned to being two-legged. I felt much more comfortable with that. I never told anybody about The Department of Amazing Stories the incident, not the school and not my parents. I didn’t know how to talk about something so out of the ordinary. I grew up with having these things happen MY LIFE: YOU WOULDN’T from time to time and I just assumed it was normal. BELIEVE! Young adult years By Bob M. While there was fantasy in my head, there was also reality. I graduated from Penn State with a Master’s The following true story appeared in the August issue Degree in electronics engineering. I worked in that of “Recovery,” a publication of the Consumer field for 16 years. I was married for 7 years. The Satisfaction Team of Montgomery County. Thanks to hallucinations would come and go, but most of the time Bob for sharing this. It’s a marvel. I was able to cope with a mind that was able to grasp enough of what went on to get along.

Introduction I remember one incident that happened at a meeting Forty years ago, my father took my mother, my brother while I was at work. Our group, which consisted of 4 and me to see a family member who had cancer. or 5 technical people, was presenting our work to Before we left, Dad sat down with my brother and another small number of people interested in the me and warned us, “Don’t shake her hand and project. As project manager for one phase of the work, don’t sit next to her.” So we didn’t. The point of my presence at the meeting was appropriate. The this is that 50 years ago this collection of meeting started and people were discussing the topic at misunderstanding and fear was what the average hand. Suddenly I began to hear these voices inside my person believed about cancer. Today nobody head. They were following along with what was going would believe that. on in the meeting. They would ask me questions, technical questions pertaining to the topic of the Today many people’s beliefs about mental illness are meeting. I would think the answer, then they would ask equally out of date. Many people look upon mental another question. How could someone so out of touch illness with vast amounts of fear. I didn’t know climb the career ladder to such a height? It’s scary. anything about mental illness until life drove me to the Naturally if my mind was busy processing voices and very extremes of reality and beyond. thoughts, there was not very much of me remaining to focus on what was actually going on in the meeting. I First grade didn’t contribute much, but nothing was said about it. In first grade, for the first time, I was surrounded by kids my own age. I could see them coming together Suicide forming friendships, organizing softball games and I had many suicidal thoughts. Like the voices, they having a good time. I couldn’t understand how they did would come and go. I started the suicidal thoughts these things, let alone that this was what you were when I was in my early twenties and continued them supposed to do. It seemed like everybody was better at into my mid-forties. Each time I would plan some way living his or her life than I was. My mind seemed to be to terminate my life. But then my next thought would slower at these things than the other kids. I was mostly be that if I did succeed at suicide, somebody would quiet, never got into trouble and got good enough have to clean up the mess. I didn’t want anybody to grades that the school passed me from grade to grade. inconvenience himself or herself by cleaning up my mess, so I went on living. This made me feel really The Teen years low, that I didn’t have enough control of my life to It was as a teenager that I had my first active terminate my life. symptoms of mental illness. I started hearing Mid-adult years voices inside my head and seeing things that Mental illness, like many medical illnesses, can get weren’t there. One day I was standing on the worse if it remains untreated. The voices told me I

23 didn’t have to work. I gave notice and left. That was 20 real, or just imaginary? If he was real, what did it years ago and I am still not able to work full time. mean? Without the structure that work provided, my condition rapidly deteriorated. My mind was in such a deteriorated state that I don’t remember how long it was before the phone rang. It At this point in my life, I didn’t have much human may have been hours. It may have been days. The contact and had no real goals. The voices came back caller was my friend John, inviting me to share almost all the time. I would have regular conversations Christmas dinner with him and his family. He could tell with them. They told me if they saw me outside, they by the way I was talking something was wrong. I told would kill me. So I stayed inside. Once a week I would him nothing that was happening was making any sense. brave the wrath of the voices and go grocery shopping. As my condition deteriorated even more, once a week John’s wife Judy was a RN with training in mental was too much. I stayed home all the time. In a brilliant health. She was familiar with the inpatient mental move, I had pizzas delivered. Every few days I would health facilities in the area. She and John got me into order three or four pizzas. I spent many hundreds of the Lower Bucks Hospital. The hospital was a new dollars on pizza. I would never order from the same experience for me and my mind started to focus more pizzeria twice so they didn’t get suspicious. This went clearly. I could see that something had gone wrong on for months. with my life bigtime. For the first time in my life, I felt respect from other human beings. I felt respect from the Finally my condition continued to deteriorate and in the staff and the other patients. It was all right to talk about winter of 1987 I stopped eating altogether. I would hearing voices. It was all right to talk about being drink only a small cup of water each day. I thought I suicidal. It was all right to ask for help from others should be drinking more than this, but the voices when you needed it. replied, “We’ll drink the water for you.” Like the boy with the three legs, this seemed odd, but it also seemed I was saved by the mental health system. 22 days later, to have some sort of reality bound to it. I still thought this same system turned against me and nearly killed about suicide, but then I always thought I didn’t want me. Since I didn’t have insurance, as soon as I started to have anybody clean up my mess. to show signs of more rational behavior, they told me I had to leave. I was so horror struck I was afraid to say The winter of 1987 was a cold winter and I let the what was on my mind. I knew I needed the full time heating oil run out. My mind was dealing with too support of a hospital, but they wanted to send me back much fantasy to do the rational thing: call the heating to where I was living. But that’s where the voices were. company. My life had deteriorated to the point where I I knew I would never make it out of there alive. How would kill myself in any of three ways. I might have could I ever trust the mental health system again? frozen to death. I might have starved to death. By not getting enough water, the toxins were building up in Eventually I wound up living with friends and family. my body and I was poisoning myself. Being with normal people helped convince me there was something good in me, and that it was worth working on to make me stronger. I found a psychiatrist Christmas dinner with John’s family I could trust. He suggested I attend a day treatment I lay there in bed, suicidal, delusional, at the extreme program. I went there but was scared they were going edge. There was enough of my mind working to realize to kill me, like the voices. After a year or two and I was going to die. I thought I’d like to go to heaven, so several changes of medications, I came to trust the staff I put my mind on heaven. Instantly I was transported and the clients at the day treatment program. I started out of my bed, and I was standing in front of a desk. to make rapid progress on my road to recovery. Behind the desk was a man shuffling papers. He continued shuffling papers for a moment, stopped and The present looked up at me. He said, “I don’t have you as coming I am fortunate that the kind of mental illness I have across at this time, Mr. M.” He knew my name, so I responds to treatment quite well. My mind has become thought this must be a part of heaven. I told him that I progressively clearer in the 15 years I’ve been in heard there was going to be a party in heaven, and I treatment. I am no longer suicidal. I don’t hear voices. I wanted to get in on the party. He looked at me again have carefully built a support network of understanding and said, “ I still don’t have you as coming across at people who I can be friends with or ask for advice if this time. You’ll have to go back down.” Well you just the need arises. Today I work part time, go out on can’t argue with this kind of person. There was a social occasions with friends and am convinced there is whoosh, and I was back in my freezing bedroom. I was something really good inside me. The man behind the more confused than ever. Was the man behind the desk desk was right: there really is a party in heaven. Every

24 time I take a step toward living a happier life, the party beauty salon is an essential part of my week. It is an gets better. obsession and an addiction that I can’t stop and am not sure I want to stop. Why? As my mind has become more rational, I can think Appointments are made weeks in advance and then back in time and see old ideas in clearer ways. Lately I checked and rechecked. The threat of bad weather have been thinking of spirituality. Why did god, if forces me to shift appointments, jockeying for the best there is a god, let me suffer so? I’m almost 60 years old time. and have been mentally ill most of my life. Surely If addictions are genetic, I come from a long line of whatever good I am going to do during the rest of my junkies: my grandmother, mother and aunt. The beauty lifetime could have been done at a much earlier age and salon is and has been a family tradition forged on with a lot less grief to others and myself. Why the decades of Saturday morning or Friday afternoon decades of suicidal tendencies? Why almost freezing to appointments. Looking good has always been a death? Why living alone starving to death? I now priority. On the day of my aunt’s funeral, my mother believe god was there all the time. God was the thought and I took my grandmother to the salon. The that prevented me from committing suicide by not hairdresser made a house-call when my mother was wanting to leave a mess for someone to clean up. He hospitalized. was gently pushing me away from making a mistake. God was the phone call from a trusted friend whose What causes such a costly addiction? What causes wife just happened to know about the mental health some women to practically tithe a portion of their programs. That was god moving me into a new phase income for this weekly ritual? Is it inordinate pride or of my life, a phase where I’ve learned many wonderful vanity? Or is it something more? things about myself and others from the imperfect It is the downright sensual pleasure of having someone mental health system. In real life, nothing is perfect, fuss and pamper me for half an hour to forty-five but it can be useful. minutes. For that period of time, I am truly special and I have recently come to believe that I know why I’m receive star treatment. It is my moment to shine in an here. It is to investigate spirituality, know the ways it otherwise world-weary time of chores, work and comes into my life and share this with others. This is obligations. It is a wonderful mood elevator which is another way of saying I’m capable of more growth, cheaper than a trip to the psychiatrist and is healthier which will result in a much more normal, happy me. than drugs. And that beats a pair of Prada shoes any I’ll find new ways to share with friends. day. I get the sense that at the present time, I’m about where The Compass agrees there’s nothing like pampering god wants me to be. I’ve gone from the confused first yourself to make you feel good!!! But, please: Facials grader to the outward-bound man. That’s quite a are not a substitute for consulting your doctor. lifetime. Are you with me? Then hold on. This could be interesting. PURSUE THE WONDERFUL… INTO NATURE

by Carolyn Constable

At 59, you’ll find Carolyn Constable out on the trails of Peace Valley Nature Center in Chalfont where she works as a naturalist. When the school buses arrive, she takes the kids out on the trails to show them the SAVING THE LAST FOR LAFFS secrets of nature. Hard to believe, she says, but many inner city school children have never seen a frog or heard its echoing harrup-harrup. As part of her Revelations of a High Maintenance classes, she invites the children to write nature poems, Junkie just as she does. “I can’t stop writing,” she says. “It’s just something inside me.” Carolyn was just named By Phyllis Lewy “third runner up” out of 70 entries for the 2003 Bucks County Poet Laureate competition. I am a high maintenance junkie. I love manicures and pedicures. Haircuts, blow-dries and color wow me. The

25 It’s the time of year that hawks migrate. Over the weekend I stood on a hill at Lake Galena and watched the broad wings fly over. They’re magnificent birds with large wings and large bodies, heading south from New England to Mexico. Their bodies are made to fly. They sail in hot air thermals – or currents - to conserve energy. ENDQUOTES A quartet of quotes from artists: Each species of hawk has its own time to migrate. They fly in flocks called “kettels.” One year when I was doing a hawk watch at Cape May Point where you “ My work is a continuous development of the same count the number of migrating hawks, our group themes and obsessions.” counted 13,000 birds in a single kettel! It was – Jackson Pollock (1912-1956) breathtaking. You can’t imagine how that looked… thousands and thousands flying right overhead. “I look at an object and say, Well, what can I do with Later on, we’ll watch for the bald eagles. They used to this? I I want to bring the object up to its full potential. be endangered, but now they’re considered – Carl Yeager, Lansdale, PA “threatened.” They fly solo, not in flocks. If you’re lucky, you’ll see one. Watching an eagle soar is a thrill of a lifetime. One time a birding class came out to When asked if he’s the most talented artist in New another hill and an eagle soared right overhead, as if on York, John Currin, whose retrospective is now at the cue. I learn these stories from other birders. Whitney museum, replies, “Of course I think that! …I always thought I was the best, even when I wasn't the best. Every artist worth his salt thinks he is the best.'' Birders are really intelligent people. I like to chitchat – from interview in the New York Times 11-16-03 with the other birders. It’s like sitting in a classroom. I talk to the retired guys. They spend their whole lives birding. The nice thing about them is you can ask them “Art gives me everything I need. It’s my religion. I turn all the questions you can think of and they’re never in a into what I paint. I become waterfalls, I become the hurry to give you answers. sky. I do it only for myself. Only what pleases me.” - Barbara Postel, Point Pleasant, PA Once you get into birding, the complexity only deepens. I guess that’s what keeps us coming back.

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