"The Center Cannot Hold" – a riveting memoir of madness

First, thank you for letting me know that length matters less than content to you – and that you like variety – in my "Coming Out Crazy" posts. My poll was minuscule, but I am very grateful for your feedback.  

I'm happy to hear it. It's much harder to write short than long – trust me on this. I worked for a tabloid – which refers to size more than content, or used to – so from now on, I will not waste endless amounts of time trying to "trim" my posts to fit an arbitrary word count. I'll say what I want to say.

To be honest, I've never cared much for numbers. Ever.

"Enough" is my favourite number.

Particularly ...  number of pounds one weighs. Number of years one lives. Number of dollars one has or does not have – or one "makes" per number of hours, days, weeks, months or years one is lucky enough to be able to work.

You see? Lucky enough. Good enough. I love "enough." Enough has no measure and cannot be quantified. It's just "enough." 

My mantra these days is – "To know you have enough is to be rich."

Those are the measures I love. Measures than are immeasurable! I don't like the word "priceless" – I prefer "incalculable." 

If you must know, and I'm confessing this here for the first time – I'm truly afflicted with numerophobia and arithmaphobia. I need a calculator to add 2 + 2 to get the right answer. And for me, the right answer is rarely 4, but a greater number, like 5 or 10 or 27 or 13,753. That's synergistic – another story!

You wouldn't want to see my bank book! 

Now then, on to bigger and better things – like moving one car out of my parking lot, for good.

Elyn R. Saks, author of "The Center Cannot Hold," was born in Miami, Florida to a comfortable family. In her memoir, she writes about living with schizophrenia, although she always refers to "battling" or "fighting" it. Language aside – and hers is not particularly positive – there are some problems in what I found an utterly fascinating narrative.

First – and this really bothered me – Saks and her editors neglected to credit Irish-born poet and playwright William Butler Yeats – winner of the 1923 Nobel Prize for Literature – for the title of her book. Maybe it's so obvious, they didn't think Yeats needed the credit. Maybe I missed it. Either way, it's relevant.

In his 1919 post-WWI poem, The Second Coming, Yeats describes the chaos of trench warfare. It perfectly mirrors the chaos Saks describes in her mind as her psychosis progressively shatters her sense of reality.

 

Here, in the first of Yeat's two-stanza poem, he powerfully evokes the madness of The Great War:

Turning and turning in the widening gyre

The falcon cannot hear the falconer;

Things fall apart; the centre cannot hold;

Mere anarchy is loosed upon the world,

The blood-dimmed tide is loosed, and everywhere

The ceremony of innocence is drowned;

The best lack all conviction, while the worst 

Are full of passionate intensity.

(Bold face is mine, not the author's.)

No mention of Yeats or his poem is made in the Saks' book. It's a small thing, but it bothered me.

More interestingly, my episodes of manic psychosis never felt remotely like her psychosis, which was more constant and with variances in intensity. 

(Perhaps her diagnosis should be schizoaffective disorder, if she must have a diagnosis. Frankly, I just prefer to think of Elyn as now in recovery from her "madness" – as I am from mine.)

When I'm psychotic, my reality shifts dramatically. I've had delusions of grandeur and believed I was God. I felt once like my car was a magic carpet flying down Bayview. Quite joyful, actually.

Yet, for Saks, her delusions are the opposite. Evil. Frightening. Monstrous. Horrifying. She believes she's the devil, that she's killing thousands of people with her thoughts.

Her wild hallucinations are often self-destructive and suicidal, too. Her vivid descriptions cut to the bone. Compared to hers, my psychotic trips were like a visit to Oz. Colourful, bright, exciting, adventurous and exhilarating.

I've read many articles and several memoirs by people with other mental disorders – mainly anxiety, manic depression or one of the bipolar spectrum of disorders. This is the first by someone who endured and remembered years of wildly "florid" psychoses in remarkable detail – all the while fighting the idea of her schizophrenia diagnosis or any need for medication.

Saks is clearly and exquisitely brilliant. She managed to complete her MA and PhD in philosophy at Oxford University primarily because of the therapy she received with a psychoanalyst. Drug free. She completed her law degree at Yale, with another psychoanalyst. Today, she continues her recovery with psychoanalysis. 

Medications play an important and necessary, but secondary role in her recovery. For Saks, it is the regular and rhythmic daily hour spent voicing freely and frankly whatever crosses her mind – and analysing the meanings behind those thoughts and words. This is the process that gives her insight. It's painstaking hard work. A lifelong process.

Why did she become psychotic? Who knows? That's debatable. At the age of eight, she remembers experiencing night terrors, fierce compulsions and feeling that her mind was crumbling like a sand castle.

After discovering an adolescent flirtation with recreational drugs, her parents, overreacting I think, enrolled her in a brutal rehab program that instilled in her an irrational fear and repulsion at the idea of taking drugs of any kind, including prescription drugs. This phobia plagued her for years.

After that, her family seemed relatively absent, according to her. Saks writes of constantly protecting them by masking her mental problems. 

The story of her struggle to survive and graduate from three universities on two continents – always far from her home and family – is riveting. She attended the best schools – Vanderbilt, Oxford and Yale – all on scholarship, desperately clinging to some semblance of sanity to prove that nothing was wrong with her mind. Her life then was an astonishing roller coaster ride starkly contrasting British and American approaches to psychiatric treatment. (The Brits were much more humane and liberal.)

Most of all, her passion and unquenchable thirst for knowledge buoyed her on and kept her focused despite long periods of psychosis and several hospitalizations. 

In the academic world, Saks found emotional and intellectual solace and sustenance. She could breathe and flourish. Outside that world, in "the real world," she was and is lost and feels threatened. Her routine breaks.

My psychiatrist recommended this memoir to me, I'm sure, because his approach to psychotherapy is psychoanalytic, which as Saks explains, is not always Freudian. There were many approaches.

Her first experience with psychoanalysis was in Oxford with a "Kleinian" therapist, who was not a medical doctor. 

Melanie Klein was "an Austrian psychoanalyst who immigrated to London in the late 1920s," Saks writes. "Unlike Freud (and later his daughter Anna), Klein believed that people with psychosis could benefit from analysis and that the necessary transference could develop. It was her theory that psychotic individuals are filled with (even driven by) great anxiety, and that the way to provide relief is to focus directly on the deepest sources of that anxiety."

I remember being told years ago, when my diagnosis was schizophrenia, that I would never be a candidate for psychoanalysis. Dr. Bob says that's ridiculous. "You never had schizophrenia," he said when we discussed this. He's been my therapeutic lifeline since 1991.

Besides her personal journey, the psychoanalytic process is central in this memoir. It strongly suggests that the bio-medical model driven by the excessive use of antipsychotic medications for psychosis – rarely psychotherapy of any kind – is not be the only route to recovery.

Once Elyn, as a young Oxford student, begins her psychoanalysis, she also begins to develop the insight that allows her eventually to begin to unravel the complexities at the base of her psychosis. This is where her healing begins.

I strongly recommend this memoir – warts and all. I don't know why it wasn't widely reviewed, but I suspect that's because it defies the mandate of Big Pharma. She was mentioned in a landmark Sunday, May 11, 2008 New York Times story in the "Style" section about Mad Pride. 

Next week is Mental Health Awareness Week, BTW!

Today, Saks is a University of Southern California professor of law. Mental health law is her area of expertise. She's well-published and openly advocates by telling her story, though reluctantly. She's never liked lecturing. She's also an adjunct professor of psychiatry at the University of California in San Diego and a research clinical associate at the New Center for Psychoanalysis in Los Angeles, where she lives.

She's still in analysis, and she's finally accepted her diagnosis and that her medication helps and not hurts her. Perhaps, one day, she will take her recovery beyond her diagnosis and stop labelling herself as "schizophrenic" – because she is so much more. Like so many others who live with and manage their psychoses, she has "a beautiful mind" but it appears that she's veering in the direction of the neurosciences. She is an academic, first. And is or plans to participate as subject and investigator in psychiatric and neuropsychological study of the brain – "and given brain scans," she reports at the end of her book. "The hope is that maybe then we can learn things that will help others."

She's now happily married to a good, kind, wise rock of man. 

I am, too. Her marriage, like mine, appears to be the wellspring of balance in her life and mind. It inspires in her a sense of security and hope.

We're both very lucky women – with more than enough.

Edging a car out of my parking lot...

Last summer, my psychiatrist Dr. Bob recommended I read The Center Cannot Hold – My Journey Through Madness by Elyn R. Saks.

This was a first. We've been together since 1991.

The only other book we ever discuss is the Diagnostic and Statistical Manual of Mental Disorders. He even gave me a little pocket edition called Quick Reference to the Diagnostic Criteria from DSM-IV – published in 1994. I treasure it.

Back to the Saks memoir. I've discovered a number of peculiarities about it. Though it was number 34 in the "Also Selling" section on the New York Times best seller non-fiction list in September  2007 – it was never reviewed and its author is mentioned only once. Saks is briefly quoted, but not about her book or herself.

Compared to the other notable psychiatric memoir I've read – An Unquiet Mind, A Memoir of Moods and Mania – published 10 years earlier by Kay Redfield Jamison, there are stunning differences.

Saks is cited twice in The New York Times archives.

Jamison, 561 times.

Saks has schizophrenia diagnosis. Jamison, bipolar disorder. Or manic depression, the term she prefers.

Both are married. 

Saks to a good, kind, supportive, rock-solid man – Will.

Jamison, to a Richard J. Wyatt, a renowned schizophrenia scientist about whom she has written her sixth book – Nothing Was The Same, a memoir – to be published in September 2009. For Jamison, a brilliant writer with an M.A. in English Literature, her second memoir is an elegy on her 20-year marriage that ended when Wyatt died of cancer in 2002 at age 65. 

Saks is a PhD in philosophy, a professor of law at the University of California, an adjunct professor of psychiatry at the University of California, and a research clinical associate at the New Center for Psychoanalysis. She prefers research. Dislikes lecturing. She's had a number of important scholarly books and papers published about her area of expertise – mental health law.

Jamison is a PhD in psychology, a professor of psychiatry at the Johns Hopkins School of Medicine, a clinician/researcher and one the leading authorities on bipolar spectrum disorders. She's written several medical texts, plus five books for non-clinical audiences. All about mood disorders. All wildly popular.

Among them – Exuberance – about hypomania. Touched With Fire examines manic depression and the artistic temperament. Night Falls Fast – about suicide – is still the first of its kind. Meticulously researched and breathtakingly written by a clinical psychologist who came perilously close to dying by suicide before being prescribed Lithium Carbonate in the mid-1970s. (Then a revolutionary pharmacological treatment for manic depression, it saved her life and successfully stabilizes her mood swings.) 

Saks' book is barely discussed. Rarely reviewed. Problematic, perhaps, it is extraordinarily compelling – the only memoir I've ever read by anyone with wildly delusional and psychotic episodes of schizophrenia yet her primary treatment was and remains psychoanalysis. She takes medication now, but for years she fought her diagnosis and often refused to stay on it.

Here, I stop. The rest of this post goes back into the parking lot. To be continued next time. 

You'll notice my posts are shorter, as they should be. This one is 561 words. I've written 1,500 word posts. Too long. I'm not writing for a magazine here. You should be able to read these on Kindle or an iPhone.

Let me know your thoughts on this. Does "length" matter?

Speak soon. 

My Parking Lot...

This post has nothing to do with cars. It's about catching up.

I took a course at Seneca this winter called Foundations of Teaching and Learning. Many post secondary teachers have little or no teacher training. We learn as we go. Unless we're lucky enough to be at a college with an enlightened attitude towards professional development – Seneca does – and many courses available to help us learn the complex theories, practice and art of good teaching.

In this two and a half hour class, our teacher, Bev Brewer, a PhD in education with years of experience, kept a running list of topics we would "get to" at the end of the course.

"This is going into the parking lot," she would say.

During our last class, we finally entered the parking lot to resolve  some of our issues.

I have a parking lot, too, here at Coming Out Crazy. So far, there are topics we've left unfinished. Or I've promised to cover and then a news story captures my fancy and that topic, even if I promised to write about it next time, goes into the parking lot.

Here they are and for the next while, I'm going to attempt to cover them, one a week, in no particular order:

1. Tammy MacKenzie and her poem, inspired by this blog, called "Coming Out Crazy" – Tammy is a regular commenter and she wrote and performed her poem first in February. Many times since.

2. A book review of The Center Cannot Hold: My Journey Through Madness by Elyn R. Saks

3. A post on Canada's proposed Mental Health Strategy, from the Mental Health Commission of Canada

4. An interview with Queen's University's epidemiologist Heather Stuart, a senior adviser on "stigma" (a word you know I detest) for the Mental Health Commission of Canada.

5. A response to Granny, one of our commenters, from months ago, that was never finished.

6. Plus a few I've put into the parking lot, including a new Broadway musical – Next to Normal – which opened last week at the Booth Theatre. 

From Ben Brantley's April 16, 2009 New York Times review: 

"Next to Normal does not... qualify as your standard feel-good musical. Instead this portrait of a manic-depressive mother and the people she loves and damages is something much more: a feel-everything musical, which asks you, with operative force, to discover the liberation in know where it hurts."

7. The word "normal"...

Please forgive me for not being as responsive as usual in the comment section.

April is the cruelest month for me – marking all my students' final papers and projects, setting exams, writing those exams (to test drive them and better be able to mark them fairly) and income tax. 

Thank you for your patience, friendship and community spirit. Our discussions teach me so much.

Speak soon.

For the love of dogs...

The big news in Washington is that Bo Obama, the newest member of the First Family, is getting his own children's book – "Bo, America's Commander in Leash" – due out in two months.

The whole continent is going gaga over this dear little six-month-old Portuguese Water Dog.

A few cautionary thoughts on this – and how therapeutic a dog of any breed can be for loving owners, prepared to invest their time and money in providing a healthy home for their dog.  

Dogs need attention. They're social animals. They thrive on love.

My little Dandie Dinmont Terriers – Riley and Lucy – give me the most enthusiastic "Hello!" when they hear the door of my car shut. My husband says they begin barking two minutes before I turn into the driveway. How do they "know" of my imminent arrival? This was true of their predecessor, Murphy the Wonder Dog.

He was a little Shih-Tzu Poodle cross – a Shit-Poo – and a St. John's Ambulance Therapy Dog. The smallest in his class, he passed with flying colours and we began visiting the psychiatric wards at Sunnybrook. 

No one else wanted that assignment, but psychiatric wards were my second home. Murphy was a huge hit on the adult and adolescent floors. He'd roll over and let everyone rub his tummy. Nothing made him or the patients happier.

When Murphy died at 14, I knew I wanted another dog – a Dandie Dinmont Terrier. Three months later, Riley came into our lives. 

Terriers are often playful, rambunctious, fun loving – not really lap-dogs, though Dandies are great cuddlers. When we brought 13-week old Riley home, he was so relaxed my sister accused me of drugging him. 

Riley is my boy – always with me – at my feet right now.

Dandies are a rare, endangered, "vulnerable" breed. Riley is not only a Canadian Champion, he's sired a Canadian and British Champion – Charlie. We belong to the Dandie Dinmont Terrier Club of Canada, a whole family of Dandie enthusiasts devoted to the preservation of this old Scottish breed. Our dogs are our pets and our passions. They love the show ring as much as hanging around the house "being pets."

Though they both graduated from socialization and obedience classes, they obey when they choose – and never if there's a squirrel or rabbit in the backyard. 

According to my research, Porties can be willful, too. Plus, they need lots of exercise. 

It doesn't matter what breed you choose, dogs need your commitment – socialization with lots of other dogs and people early in their lives – and training. Grooming, exercise, good nourishment. They need regular veterinary care, which is costly – including dental care. 

Most of all, they need to be adored.

Because the Obama's chose a specific breed doesn't mean that breed is right for you. Or that breed should become the "object du jour" – dogs aren't trendy objects.

They're like little children who never grow up. My Dandies enjoy their routine and are happy because they're rarely alone. When they are, they have each other. 

So, if you're considering adopting a dog, do your research. Find out what breed suits your lifestyle. If you want to rescue a dog, remember, a rescue dog may have emotional baggage and need extra love and care. Be patient and prepared to invest your time, money and especially your love in your dog. 

When the world seems too much for me, stroking one my Dandies instantly calms me. Their unconditional love is unlike any I've ever known. That's healing.

Here's to us!

Last week – and I can't believe this – I completely forgot the first anniversary of healthzone.ca and Coming Out Crazy.

One year ago, we launched on April 9. It slipped my mind.

It was a crazy day. The day before Good Friday. The night of the second Passover Seder. A short week. I was buried under my Seneca students' assignments while my editor, Brandie Weikle, was doing what she normally does in five days – in four. 

Complete madness. 

So, in honour of this auspicious anniversary – a few reflections on the past year.

It all started with an email from Brandie asking if I'd consider writing a mental health blog for a new Toronto Star website. Why not? We met. Clicked. The name was a no-brainer, and we were off to the races.

Three weeks later, Coming Out Crazy launched on healthzone.ca, one of three new websites at The Toronto Star. The other two are parentcentral.ca and yourhome.ca. Brandie was running two of them; yourhome.ca is run by newlywed home-hunter Jennifer Wilson. 

A year later, all three websites are going strong. Brandie has her own blog about her adventures as a working mom with two very young, active, curious and amusingly mischievous boys.

As for me, blogging was virgin territory. I rarely, if ever, read blogs, didn't Facebook and had never heard of Twitter. What was the New Media? What was the Social Media? 

I hadn't a clue. What a difference a year makes.

Last April, we were not yet live, either. There were no comments. No links. No interactivity. Communication was limited to email. I responded, but there was no sense of spontaneity. At the same time, I was researching blogging – roaming the blogosphere, getting my feet wet commenting on and exploring millions of other mental health blogs all over the world. What an education. 

Then, in June, we went live and hit the big time. I began to experience first hand that a blog is really a virtual "community" – world's apart from "print" journalism. I had the privilege of "meeting" and engaging with you. 

And you're fascinating. Often brilliant. Insightful. Knowledgeable. Poetic. Humourous. Sometimes hurting. Angry. Confused. Always interesting. And you bravely opened up here. Through our sharing, we started coming together – our community was forming.

We were beginning to understand each other. Feel for each other. And feel connected. Perhaps healing each other, too. 

Meanwhile, I was linking to other fascinating sources, writers and thinkers, therapists and people with "lived experience of the mental health care system" – raising more issues, more questions, more concerns. In sharing your stories, you were teaching, encouraging, motivating and inspiring us. Making this a safe and "mad" little haven, and proud of it. The Coming Out Crazy cranny!

On my 60th birthday, Coming Out Crazy won an amazing award from psychologist John Grohol at PsychCentral. Several months ago, I started posting COC on Facebook and meeting a whole new world of people. I'm even Twittering, a little. Making more connections.

This community has come together because of you! 

And my editor, Brandie. 

She wanted a mental health blogger on healthzone.ca and chose me. She's taught me more about "the new media" and "the social media" than anyone else. She is the ideal editor, with a light touch and a discerning eye. Always happy to encourage me and brainstorm ideas. She has great instincts. 

Every writer needs an editor, and Brandie is the best. 

Along with you. I want to thank you. Your comments brighten my day and challenge me. You prove what I've always sensed – that we have so much hope to share. Hope is contagious. Peer support is a powerful healing force for recovery when we listen, learn from each other – and feel free to be ourselves.

Together, we've created this enlightening and caring community for the world to see. 

So, Happy Anniversary! Here's to us!

Philip Dawdy in the spotlight...

This was quite the week for Philip Dawdy of Furious Seasons, who I often link to and quote, here.

You may wonder why I don't post more about pharmaceuticals and mental illnesses, conditions, difficulties and disorders. And Big Pharma.

Simple. Dawdy is an award-winning Seattle-based investigative journalist and he has this beat nailed. 

He's a "must-read" for me, even though he writes from an American perspective and Canadian issues differ somewhat because we have a different healthcare system. 

I don't always agree with Philip, but I'll agree to disagree because his area of expertise and the ethos of his blog are completely different from mine, though we have both been diagnosed with bipolar disorders. He's off meds. I'm not. He's up to the minute on all American psychiatric drug-related issues and he has a vibrant comment section. Sometimes too vibrant, even for him.  

Most importantly, Philip is a professional journalist with ethics. I respect him. He's probably the most authoritative, passionate, knowledgeable, thorough and savvy writer on this subject in the U.S. where big problems are brewing around the antics of several psychiatrists and Big Pharma, ethically questionable diagnoses of and treatment of childhood bipolar disorder – which may not even exist – ADHD and other psychiatric controversies that keep him very busy.

Philip covers and uncovers these strange bedfellows often and well. 

(BTW. When I was first sent to a psychiatrist in the early 1960s, children and adolescents were never diagnosed with bipolar disorders or manic depression, as it was known then. It was unfathomable that these "mood" disorders could affect young minds. So, we were slapped with "schizophrenia" diagnoses, if nothing else fit. To have a "thought disorder" was the diagnosis du jour for kids back then. ADHD hadn't been invented and the DSM was much slimmer. Psychopharmacology was in its infancy.)

Today, the propensity to diagnose young children with ADHD and bipolar disorders is not only an American phenomenon, as Philip contends, it spills into Canadian psychiatric practices, too, though not to the same degree. But it is by no means universal.

Philip has reported on stories months before they turn up in the mainstream media, including The New York Times and other newspapers. He always cites and credits his sources – including other bloggers. This is a very hotly followed facet of mental health in the American blogosphere. The mainstream press is picking up on it, too. Sadly mainstream media reporters rarely credit Philip, even though he does all the work. Too often, it's stolen from him by writers paid to write. (Philip is completely independent, supported by his readers.) 

Independent mental health bloggers have to contend with this and seem to exist in a parallel universe. They rarely get much play in the mainstream media, especially when they go head-to-head with the allopathic, bio-medical, neuroscience-oriented psychiatric paradigm which is joined at the hip with Big Pharma.

That's why, this week, Philip hit the jackpot, when, finally, the spotlight shifted and shone on him. 

He and his views on "the bipolar child – a purely American phenomenon" were the focus of an in-depth interview with Christopher Lane on his Psychology Today blog, Side Effects. It showcases his knowledge, research, and especially his concerns about the way pharmaceutical companies and the drugs they develop drive diagnostics.

In this interview, he's controversial, provocative, and as always, candid.

He's already received some flak. in comments on the Side Effects site. He posted about it, on his, too – but generally the reaction was terrific. This is politically and emotionally thorny territory. Lane offered Dawdy a wide berth and a rich opportunity to speak out based on his years of mental health writing and reporting, not only on his blog but as an "all-star" staffer for The Seattle Weekly.

He does his homework, including solid original research, plus careful monitoring of the press and reading "tons of journal articles." As an investigative reporter, he has a keen understanding of "government and law enforcement ... I know where to snoop," he says in the interview adding that he hasn't "read a novel or nonfiction book outside of the mental health world in about three years."

In 2002, TIME magazine ran a then-surprising cover story – Young and Bipolar – mentioning the work of a husband and wife team – psychiatrist Demitri Papolos and his wife Janice. It featured their book – The Bipolar Child –  which was published in 1999 and was based on studies of 300 "bipolar kids ages 4 through 18." I'm looking at that book right now because I read it back then and wrote a feature based on it, interviewing the Papolos's. The most outstanding facet of their work, as I recall now, was how essentially unscientific it was. Frantic parents unable to cope with their "difficult" children, seeking out Dr. Papolos because he would medicate them and calm them down. Make them more manageable. 

(That's what happened to me when I was hospitalized in the 1960s and 1970s. I was a zombie on Chlorprormazine – the original antipsychotic – or Haldol, one of the first typical antipsychotics. Semi-comatose – but more manageable.)

Who was "The Bipolar Child" written for, I remember wondering at that time. Who were these drugs really benefiting? The child or the parents? The teachers? Philips sounds off on this, too, from a contemporary perspective. He and Lane cover a lot of ground..

The Papoloses had relatively little scientific evidence to back up their work in the 1990s. Mainly anecdotes. They were working in the dark. With good intentions, I'm sure. Their book is still a parents' guide. 

Who advocates for the kids?

What Dawdy is meticulously reporting today is what they, 10-years-ago, couldn't possibly have known. That these atypical antipsychotics and anti-depressants have side-effects on the developing brain. And side-effects not only for kids, but for adults, too, as it turns out. 

If prescribed, they must be monitored very carefully. They aren't wonder drugs for everyone. And everyone is different. That's the key.

This week, I happened to correspond with Tufts University professor and clinical psychiatrist Ron Pies, on a different question but one related to psychiatric treatment, including medication. Pies and I met through this blog and he has become a wise and valued resource and friend. He is a clinician, professor, researcher, a prolific writer and published poet, who happens to be Editor-in-Chief of Psychiatric Times. He has authored several psychiatric texts on diagnostics and psychopharmacology.

In our correspondence, Ron said, "I virtually never advocate medication alone – in fact, without a strong therapeutic alliance, periodic monitoring, etc., simply giving patients a powerful medication and sending them out the door is potentially dangerous."

That, I think, says it all. 

The perfect pill ...

I'm exuberant. Can't help it. It's my nature. That's why I was first sent to a psychiatrist. Histrionic, they called it. Dramatic. Exaggerated. 

As a child, my nickname was Sarah Bernhardt.

Sadly, even 49 years of psychotherapy hasn't changed this in me.

It can and often is a real problem for a lot of people, especially those close to me. I've always been exuberant. Really irrepressibly animated. Upbeat. Bouncy. Larger than life. Fast thinking and faster talking. My husband says I never stop to breathe. He can't get a word in.

I'm a true extrovert who thinks and talks at the same time. And fast. I derive my energy from engaging with others.

I burst out of bed in the morning and instantly, I need to connect with people. I start making phone calls or if it's too early, I check my email – before I brush my teeth. I'm constantly checking, connecting. I thrive on connecting.

You cannot miss me at a dinner party. I have to rein myself in sometimes. I can become euphoric without any chemicals at all. High, on Perrier and lime. Happy, joyful, animated, lively. I can drive my family crazy.

Oh, I can listen, too. Really intensely. I'm an exuberant listener. 

My mood stabilizer prevents me from becoming so manic I become psychotic. But for the normal everyday hypomanic moments, for the little madnesses that I bring to everyday activities from teaching to grocery shopping to walking my dogs – yes, I'm an exuberant dog walker, too – what to do?

(This term, one of my students actually told me I was too charismatic to be a teacher!)

Well, at last, a new pill has been developed and it's just received FDA approval – a prescription depressant called Despondex.

This may be my salvation. 

Have a look.

Peace, at last.