Book review: Should I Have Told You That?

book cover: Should I have told you that

In Should I have Told You That?: A Memoir, Liz Lea doesn’t pull any punches; she sets the tone for this early on, writing that her grandmother hated her, and it was mutual.  The book is written in a chatty tone, kind of like you might expect if you sat down with someone and they were regaling you with tales of their adventures (not to mention misadventures).  The short chapters help make it easy to read.

The author shares her struggles with multiple health issues, in particular bipolar disorder and chronic severe migraines (and throw in some hypothyroidism for good measure).  These had a significant impact on her level of functioning, and led to major changes in her life compared to the escapades of her early 20’s.  She shares about her multiple hospitalizations for bipolar disorder, as well as the long and difficult road, involving countless ER visits, to find safe and effective treatment for her debilitating migraines.  Despite it all, though, in this book she demonstrates that she has been able to move forward with recovery.

Much like how someone might tell their life story verbally, the book jumps around temporally; as a reader, I found this made it a little hard to follow at times.  Overall, however, the book feels like it gives the reader a genuine look into Liz’s life, with nothing being held back or prettified for publication.  This is real life.


You can find Liz on her blog The Liz Lea.


You can find my other book reviews here.

A little reflection

castle reflected in Lake Bled

Yesterday I saw that I was only a few followers away from 1000.  And instead of feeling excited, I wasn’t feeling very good about it.  All along I’ve tried to take the approach of looking at and thinking about numbers as little as possible.  It can be hard to avoid, though.  One of those things I couldn’t help but notice is that in the month of May my number of views has gone down compared to the previous month for the first time since I started blogging.  And that is what it is, but decreased views plus increased followers is a bit of a weird combination; enough to trigger various uncertainties and self-doubt in my head that I don’t think I’d be having if it weren’t for that odd mismatch.  I’ve never intended to try to monetize my blog, so that’s not an issue.  It seems utterly ridiculous to be questioning my place in the blogging world when I’m at almost 1000 followers; how arrogant is that?  Yet if all these people are following me but only a small percentage are actually looking at what I write, does the follower number actually mean anything?  In a word – no – but throw depression into the mix and self-critical thoughts flow oh so easily.  And I guess it goes to show that insecurity is less about absolute numbers and more about how the mind twists things.

In the end, I decided to comb through and remove the followers that were clearly just link spam (male enhancement, topless waiters in Melbourne, etc.).  And, like I always try to do whenever I get mired in this particular rut, I just need to bring the focus back to the stuff that actually matters, and consider what I have (some really, really awesome followers) rather than whatever I might perceive that I don’t have.

Is there anything that tends to trigger blogging insecurity for you?  How do you overcome it?


Image credit: 12019 on Pixabay

3.2.1 Quote Me!

antique watch

Thanks to Rory at A Guy Called Bloke and K9 Doodlepip for tagging me for his new game, 3.2.1. Quote Me!  Here’s what he has to say about it:

Everyone loves quotes right?

So l figured to introduce a bit of light hearted fun with this series. It’s simple:

Every day l will pick a topic, post 2 quotes and nominate 3 bloggers, who in turn will post 2 quotes on that topic and nominate 3 bloggers of their own and let’s see how far we can take that topic for the day.

Rules: 3.2.1 Quote Me!

Thank the Selector

Post 2 quotes for the dedicated Topic of the Day.

Select 3 bloggers to take part in ‘3.2.1 Quote Me!’

Topic For Today: Age – Age, Ageing, Aged.

“The old begin to complain of the conduct of the young when they themselves are no longer able to set a bad example.” – François de la Rochefoucauld

“Life is like a roll of toilet paper. The closer you get to the end, the faster it goes.” – Anonymous

I tag:


What’s in a name? Labelling and mental illness

dictionary excerpt

I’ve written about this a few times before, but the language people use when it comes to mental health  is so important that I could probably talk about it ad nauseam.  There are a lot of words that get tossed around to describe who we are and what we experience, and in this post I’ll consider a few of them and whether they are helpful or harmful.

Role identities

We all have multiple different role identities; this is a sociological concept that refers to identities that are defined around a certain role. Some of my role identities are daughter, sister, nurse, and person with depression.  The weighting placed on the importance of these role identities varies greatly, both by individual and by context.  Mental illness awareness campaigns will often say that we shouldn’t refer to people by an illness identity, e.g. he is a schizophrenic, because it doesn’t define who they are.  I believe we all have the right to have control over our identities and those aspects of our identities by which we wish to be known and understood.  I know bloggers who describe themselves as being bipolar, for example, and that is completely okay, but I don’t think that others should try to impose an illness identity upon us.

Are we patients?  Consumers?

Then there is the question of what terminology to use to refer to those of us living with mental illness and our relationship with mental health services.  Consumer, psychiatric survivor, patient, client, person with lived experience…  There are lots of terms floating around out there, and everyone seems to have a different preference.  I don’t like consumer, because to me it sounds like an economic term, and one that is based on service use rather than personal experience (I dislike service user for a similar reason).  While we are certainly survivors, the term psychiatric survivor seems to suggest a very antagonistic relationship with the mental health care system, and while that’s certainly the case sometimes, it doesn’t seem like a particularly productive way of defining ourselves.  I actually like the term patient in certain contexts. I know it’s fallen out of favour for the most part, but for me it comes back to the idea of role identities.  I play the role of patient at certain times and in certain contexts, although it doesn’t define me as a person overall.  As a nurse I talk about my patients because I’m interacting with them as they are engaging in that role, not because I see patient as their defining identity.  I often refer to myself online as a person living with mental illness.  I know some people use the term “suffering” and others quite dislike it; I don’t have strong feelings either way.

Mental health as synonym for mental illness

I’ve always been a bit puzzled when I see “mental health” used as a synonym for “mental illness” (e.g. “I have mental health” used as a substitute for “I have a mental illlness”).  I know it’s reasonably common, but to me it seems like a misnomer.  Perhaps it’s sometimes used as a euphemism (somewhat like mental health “issues” or “problems”), but my personal preference is for a bit more specificity.

Vague language

The problem with nonspecific term is that vagueness can leave a lot of room for misunderstanding.  One of my pet peeves is “nervous breakdown”.  It’s not a term that has any psychiatric meaning; it’s just something that’s thrown around haphazardly to describe a random assortment of experiences.  The vast majority of people out there in the world are clueless enough about mental illness without muddying the water with amorphous terminology.

Derogatory terms

There are a lot of derogatory terms that relate to mental illness, including crazy, nutty/nutbar/nutjob, psycho, bonkers, insane, looney tunes, etc.  I admit that I use these terms, but not to criticize people with mental illness.  If a “normal” person was doing something bizarre (I could insert a Donald Trump reference here but I’ll restrain myself), I might say that person is “batshit fucking crazy”.  Or sometimes I might use the word “crazy” as a good thing; for example, I really like helping patients who are highly psychotic, so I might express my preference as “the crazier the better”.  I sometimes describe myself as crazy, and I recently saw another blogger write about being a fruit loop in a positive sense.  I guess what I’m trying to say is a lot of it comes to down to intent and context.  Words like crazy aren’t going anywhere, but I think we can take away some of the power they have to harm, perhaps in the way that members of the LGBTQ community have taken ownership of words that were once used against them.

“She’s so OCD”

We also have “normal” people co-opting mental illness diagnostic labels to refer either to themselves or others.  OMG, I can be so OCD sometimes.  She is, like, so bipolar!  The guy I like didn’t respond to my text and now I’m totally depressed!  I tend to consider this use of language to be more harmful than the casual use of derogatory terms, because it significantly minimizes and invalidates the experiences of those who actually have those illnesses.  I’m not sure what we can do to change this aside from calling it out when we see it.

Diagnostic labels

That brings me to diagnostic labels applied by the medical profession to people who have mental illness.  For some people, a diagnostic label can feel like an attempt to cram them into a small box that doesn’t have room for individuality, while others might find diagnosis liberating, as it helps them understand what they’re going through and what treatment options are available.  For me it’s been more the latter.  A diagnosis is not who anyone is; it’s a framework that describes certain elements of experience that tend to be shared among people with the same diagnosis.  Getting a diagnosis doesn’t change who a person is or what their personal experience is, although unfortunately there are some people who are going to judge us based on that label.

What are your language preferences or pet peeves when it comes to mental illness?


Image credit: PDPics on Pixabay


Revenge of Eve's Get 2 Know G2K

It’s time for another round of Get 2 Know (G2K) over at Revenge of Eve.  This week’s questions are:

  • Who would you meet had you the chance? Maybe Queen Elizabeth.  She’s been up close and personal with so much of what’s happened in the world in the last 90 years.
  • What is your favorite sport? Being Canadian, I’ve got to go with hockey.
  • Where do you plan to retire? It’s less a where than a what.  A hobby farm, with chicken and sheep and guinea pigs.
  • When were you last happy? I don’t remember.
  • How do you define happiness? A sense of purpose and hope.
  • Why is self-care so important? Because no one else is going to take care of us.

Journal prompt: Write a hello to the person you chose to meet.

I don’t meet anyone these days because I hate people, so “hello; goodbye” is about all I would typically say.


To participate:

  • Create a post answering the above questions.
  • Title your post G2K
  • Use the header image as your image.
  • Use #g2k in your post settings
  • Create a pingback linking you to this post.
  • Write the journal prompt in your private journal or on your post.

My relationship with death

mourning candle

Content warning: This post talks about suicide, but not in the present tense.  You can find info here on crisis lines.

I’ve always thought my reaction to death was a bit weird, in that I’ve never had a strong reaction to death.  Part of it is that I view death less as a loss and more as a natural transition, and part of it is probably how I think about people who are aren’t physically present.  I’ve always tended to have an out of sight out of mind sort of view of people I don’t have regular physical contact with.  This has popped up in various ways, and is probably a big part of why I’ve never been good at maintaining long-distance friendships.  In a way death feels like the same thing taken to an extreme, a twisted form of object impermanence.

My dispassionate view of death has become even more firmly entrenched since my first episode of depression.  Sometimes when my depression has really bad I’ve had thoughts of suicide.  I’ve attempted suicide four times outside of hospital plus several times in hospital.  It seems unrealistic to me that I would live until a natural death (which, given my genes, probably would happen until well over 90).  I just can’t imagine living another 50+ years, and I’m ok with the idea that my life might end prematurely due to suicide.  It’s not necessarily an outcome I actively desire, but it seems the most likely.  While I do reach out for help with my depression, I don’t disclose to health care providers when I have active thoughts of suicide.  It’s not an issue right now, but most likely it will come into play at some nebulous point in the future.

As my depressive illness has progressed, the future seems very indistinct.  I have a hard time imagining what my life might be like at 50, 60, or beyond.  I’ve got no partner, no kids, a small family, and only one friend.  Life is something I just keep doing out of momentum, not because there’s anything to look forward to.  I sort of feel like that should disturb me, but I’m pretty indifferent.

My grandma, who I’ve always been very close to, is 101 years old, so clearly she doesn’t have long to live.  And I wonder sometimes how I’ll react when she dies.  Will I grieve?  Or will I just shrug and move on, all the while hating myself for feeling that way?  I don’t know, but I’m inclined to think the latter.

Death and I have a weird relationship.  Please don’t worry about me; I’m fine, this is just something I think about sometimes.

What is your relationship with death like?


Image credit: geralt on Pixabay

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format.  Feel free to join in the fun with your own answers to any of all of the questions 🙂


Questions from Michele at The Hippy Chic:

  1.  Whom do you have in your day to day life that inspires you?  My grandma is 101 years old and hasn’t lost her sense of humor and cheery outlook on life.
  2. What crises has God pulled you through recently?  Well, I’m an atheist and God hasn’t made a guest appearance in my life up until this point, so I’m chugging along on my own.
  3. List 5 healthy coping strategies you have incorporated into your life that have replaced any bad habits or addictions?  Luckily I have never had to battle addictions.  For bad habits, I don’t know that I’ve found replacements; it’s more that I’ve just redirected my energy in other directions in general.
  4. What is your all time favorite band?  I’ve generally not been all the attached to specific band, so I’m going to go back to my childhood and say New Kids On The Block.  I was a Jordan Knight kind of girl, by the way.
  5. Are you happy?  Nope.
  6. What is your favorite movie and why?  Dirty Dancing.  I loved the dancing, and I wanted to be Baby and bump n grind with Patrick Swayze.
  7. If you could dine with your hero, who would that be?  I’m going to back to childhood again for a different hero, and say Raphael from Teenage Mutant Ninja Turtles.  I had a crush on him at the time, despite the fact that he wasn’t human, but that’s just a minor detail, right?
  8. How do you give back or pay it forward?  I’m not sure.  Maybe I just try to avoid back or forward.
  9. In what way does music impact your life?  I always listen to music when I’m driving, and it almost feels like it seals out the world.
  10. What gets you excited, or willing to rise every morning?  My guinea pigs expect to be fed.  If they hear me flopping around in bed they assume I’m awake and start squeaking away to get my attention.
  11. Do you consider yourself worthy of love and admiration?  Hmm, good question. At the core, yes, but I’ve got all these walls up that people would have to get through first.


Questions from Rory at A Guy Called Bloke and K9 Doodlepip:

socks with a hole in the toe

Now these questions are supposed to be answered on the back of a dirty used sock, but I figure a stinky toe sticking out is close enough!  And on a side note, I think toenails are extremely ugly and are best hidden under nail polish.


1.. WhAt is the WEirDeSt thing about you?

I’m sure there are lots of things, but the thing that even my Grandma makes fun of me for is getting up around 3am every day just because.

2. If you had a choice to be haunted by a ghost, who would you pick and why?

I’m going to play it old school and pick Jacob Marley.  All those chains clanking around adds a certain je ne sais quoi.

3. Which cartoon character do you resemble the most??

I’m going to say She-Ra Princess of Power, just in case saying it might actually make it true.

4. Is there anything orange within 10 feet of you right now? WHAT???

There is an orange member of the pen family I use to spice up my journal.  A little further afield there’s some orange on my bookshelf but that’s about it.

5-8. John Belushi in Animal House 1978 is a classic, however if you haven’t seen it, nor care for it, well it isn’t! However the question IS have you ever been involved in a Food Fight?? Fess up, how, when , why?

Never seen Animal House, and don’t think I’ve ever been in a food fight.  Perhaps the closest I came was when I was 19ish and had a McDonald’s cheeseburger eating contest with a friend.  I conceded defeat at 6 because it felt like I’d consumed toxic amounts of salt, and she kicked my ass.

9. Have you figured it out yet and if so what is the point? That’s the question, not 2 B or not 2 B but the point?

I haven’t figured out much of anything, but perhaps if I guessed B2-B5 I might sink a battleship.  I also have absolutely no idea what the point is, so I’ll turn to the guinea pigs, whose emphatic answer would be vegetables.

10] Which was better, above or below and why? And if Neither, show us yours!

Cars, because it’s quirky.  But here’s the question, is he having sex in his car, and if so, what is the geometric layout?

11] What is the opposite to being scared of heights?

Being ensconced in a cozy cave with a guinea pig and a cup of tea.


That’s it for this week’s edition of 20(ish) questions.  Come on, you know you want to answer a few – that’s what the comments section is for!


Image credit:

qimono on Pixabay

congerdesign on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • For self-care, I went to yoga once, had a massage, and went out for coffee a couple of times.
  • Sleep was not great this week.
  • I worked at both of my jobs this week.  One went smoothly.  My other job I only work nights because it’s the only way I can handle the bullshit factor, and I worked Wednesday and Thursday night.  The person I was working with is great, but there were some other assorted elements of the workplace shitstorm that jumped out of the woodwork to bite me in the ass and make me feel shitty.
  • I only did one 30min writing session for the 2nd version of my trauma account. Avoidance is really ramping up and next week I want to put some effort into pushing through that.
  • I think the monster that would normally eat socks in the dryer has taken up residence in my vacuum cleaner.  I vacuumed up a ton of hay the guinea pigs had kicked up out of their cage.  Then I was going to empty the canister thing that holds the vacuumed up dirt, and there was no hay to be found.  At that point it was a mystery that needed to be solved, so I took all the pieces apart.  No hay.  Mystery unsolvable other than pinning it on the dryer/vacuum monster.
  • I get frustrated easily when I’m trying to explain things to people and they don’t get it.  I depends partially on the context; I’m very patient with clients in my work as a nurse, but I get very frustrated dealing with nursing students who sometimes aren’t all that bright.  I’ve been helping a friend who’s in nursing school right now and sometimes, such as this week, I just want to shake this person to make them engage the brainpower that I’m pretty certain they do actually have.  I try not to direct my frustration outward for the other person’s sake, but then it just ends up bubbling away inside of me.  I try to remind myself that it’s not actually my problem, but at the same time this person is my friend and I want them to do well.


How has your week been?


Image credit: Rawpixel on Pixabay

If I’ve ignored you lately, it’s Wordpress’s fault

Wordpress logo

WordPress annoys me from time to time, but this time they’ve outdone themselves.  I think many of us have experienced legit comments ending up in our comments spam folder.  I just discovered that over the last month or so WordPress has been sending legit comments not just to my comment spam folder but also the trash folder.  I’ve come to accept that I need to check my spam folder recently, but I never thought to check the trash folder.  Argh!!!!!  There’s a shot of my computer screen below so you can see what I mean about the different comment folders.


So if I’ve ignored your comments, it was because WordPress threw them in the trash.  Damn you, WordPress!  And what further annoys me is that, like you can see in the shot above, there’s no way to respond to comments when they’re in the trash, so now I have to manually go back over the last month of comments to find them so I can respond.  I am so not impressed right now.

Maybe stupidity is contagious?

Quora logo

I’ve done a couple posts before about the wild and wacky questions and answers on Quora, a free-for-all of stupidity interspersed with a few brave souls trying inject a little bit of accurate information into the mix.  Here are some of the gems I’ve seen recently:


Question: Are mental illnesses like depression contagious?

Answer (from someone who claims to be a “fully qualified psychotherapist):

Depression is a man made illness. Yes, it can be contagious due to the fact we are empathetic (for the most part discounting psychopaths etc).
Depression does not work as a medical disease i.e. it can not be caught by breathing the air, but it can be caught by emapthising [sic] with others blight [sic].

Depressed people also generally will not express anger correctly and as such turn it inward on themselves rather than having a conflict which will promote change. If a group of people feel this powerlessness then that depression will spread quickly.

Another answer: Depression has a physical cause. Mostly depression is caused by the high amount of sugar people eat, as well as the “other” forms of sugar like high fructose corn syrup, and fast absorbing carbs like white bread. People who eat well and exercise, can deal with most issues, and the little stress that a person may encounter when having to listen to someone’s problems, is easy to deal with.

Question: When a person who’s schizophrenic looks in a mirror can they sometimes see the other other personalities?  How different do they actually look?

Question: Do psychiatric drugs cause chemical castration?

Question: Is shoplifting tied to Abilify or schizophrenia?

Question: Would mental health checks once every 5 years for gun owners help prevent the mass shootings epidemic?

Question: Should we not allow those with mental health histories to drive, since they may run over someone?

AnswerI couldn’t resist giving my own snarky answer to this one:  Maybe we shouldn’t allow anyone who’s human to drive, since they may run over someone.

Question: Why are schizophrenics so reluctant to take their medicine when doing so would make them “normal”?

Question: Are schizophrenia and schizoaffective disorder a side effect of demonic possessions?

Question: How do people with serious depression die?

Answer: I won’t repeat the exact answer, but some jackass decided to graphically describe all the various people he knows of and exactly how the committed suicide.  And why do they do this, pray tell?  Well, here’s this dumbass’s brilliant answer:

Depressed people have immune system issues. Their immune system is up and down continually and thus many people have almost constant flu, fevers, infections, bowel issues, skin diseases, etc, for which “medical science” seems to have no cure. Despondent, these people find their own cure, usually with a pill overdose washed down with alcohol. We must forgive and pity them.


So given the rampant stupidity out there in the world, I’m thinking that maybe one strategy for fighting stigma might developing some kind of IQ booster that can be aerosolized and sprayed over the world at large.  Is that too much to ask?

My mental illness is a member of the family

family of elephants

It’s easy for me to focus on how my mental illness has affected me, but it has also profoundly affected my family, and that’s something that perhaps I should give a bit more thought to.

When I first became ill in 2007, I didn’t say anything to my parents or brother, although my mom thought something seemed off.  I’m told that I called my parents after I’d been in hospital several days since my 2nd suicide attempt, but I told them that I didn’t want them to come to visit me.  My mom ended up taking a couple months off work and stayed in my condo while I was in hospital (they live 4 hours away).  She didn’t approve when I became romantically involved with another patient, and as a result I stopped talking to my parents for several months.

When I got sick again in 2011 I realized that I needed to go into hospital, but I wanted to do it in the city where my parents live rather than the city where I live and work as a nurse.  Apparently my dad drove down and picked me up, and then took me to the hospital, where I would spend the next 2 months.  My parents really noticed the memory loss I had from the ECT, as I would ask them the same questions over and over.

The next summer I completely fell apart just before leaving on a trip to Russia.  I called my parents from my hostel in Moscow sobbing uncontrollably.  I can only imagine what that must have felt like for them.  Several months later I decided to return to hospital in the city where my parents lived.  I was really unhappy with how I was treated during that hospitalization and fought the treatment team every step of the way.  I was discharged still very unwell, and my parents were extremely concerned.

A couple of months later I attempted suicide and ended up back in hospital.  I called my brother to let him know.  He came over to my place to take care of my guinea pigs, and while he was here he cleaned up the mess I’d made when I urinated on the floor.  When he came to visit me in hospital, I asked him to get rid of my suicide note so our parents wouldn’t see it (I didn’t realize at that point that the police had already taken it).  That was the only time I’ve ever seen him cry.

When I got sick in 2016, I broke off all contact with my family for over a year, thinking that they would judge me and I couldn’t deal with that.  I resumed contact last fall, but it’s been tough.  I still don’t feel comfortable sharing much with them.  My parents are judgmental; not in a malicious way, but more that they think things should be done in a particular way and doing them differently is just plain wrong.  It’s how they are and how they’ve always been, but what I used to roll my eyes over and joke about with my brother and grandma is now something I’m very wary of.  I also find that with my family I have a very hard time putting on the superficial act of normalcy that I would use with strangers.  So I have nothing superficial and casual to say, and I don’t feel comfortable sharing anything deeper about myself, which makes for pretty scanty conversation.

I don’t think my grandma every really did understand much about my illness, but now she has started dementing and doesn’t even remember that I have a mental illness.  She occasionally makes stigmatizing jokes about crazy people, and I know I need to just let that go.

This mental illness journey is never one we truly walk alone, no matter how alone it may make us feel.  It’s the kind of illness that leaves its mark not only on us but on those that love us, and I almost feel like I owe my family an apology, even though the depression isn’t my fault.  I feel very far away from my family, and I don’t know when/how/if that’s going to change.  But right now the only way to bring about any kind of change is by continuing to work on myself.  The future will be what it is.

How has your family been affected by your own illness journey?


Image credit: designerpoint on Pixabay

Evidence-based treatment of bipolar disorder: The CANMAT/ISBD guidelines

path forks into 3 possible decisions

In 2013 the International Society for Bipolar Disorders and the Canadian Network for Mood and Anxiety Treatments combed through the scientific literature and put together these guidelines for the pharmacological treatment of bipolar disorder.  Treatments are classified as 1st, 2nd, or 3rd line based on the strength of existing evidence to support their effectiveness.  Also included are treatments that are sometimes used in bipolar disorder but for whatever reason don’t necessarily have a research base to back them up.

No treatment guideline in the world is going to be able to say what treatment is going to work in a specific individual.  However, they can provide a good idea of what has the best chance of working, and I think it’s always valuable to know what your options are.

Here are the recommendations for acute mania, acute depression, and maintenance treatment.

Acute mania

1st line:

2nd line:

  • carbamazepine (mood stabilizer)
  • haloperidol (typical antipsychotic)

Not supported by evidence:

  • gabapentin
  • lamotrigine
  • topiramate


Acute bipolar depression

1st line:

  • lithium
  • lamotrigine
  • quetiapine
  • lithium/divalproex + selective serotonin reuptake inhibitor (SSRI) or bupropion
  • olanzapine + SSRI
  • lithium + divalproex

2nd line:

  • divalproex
  • lurasidone (an atypical antipsychotic)
  • quetiapine + SSRI
  • modafinil (stimulant)
  • lithium/divalproex + lamotrigine or lurasidone

3rd line:

  • carbamazepine
  • olanzapine as monotherapy (i.e. the only treatment)
  • electroconvulsive therapy (ECT)
  • lithium combined with carbamazepine, pramipexole, or an MAOI antidepressant
  • lithium/divalproex + venlafaxine or tricyclic antidepressant
  • lithium/divalproex/carbamazepine + SSRI + lamotrigine
  • quetiapine + lamotrigine

Not supported by evidence:

  • gabapentin
  • aripiprazole
  • ziprasidone

Acute bipolar II depression

1st line: quetiapine

2nd line:

  • lithium
  • lamotrigine
  • divalproex
  • lithium/divalproex + antidepressant
  • lithium + divalproex
  • atypical antipsychotic + antidepressant

3rd line:

  • antidepressant monotherapy
  • quetiapine + lamotrigine
  • ECT
  • N -acetyl cysteine
  • T3 form of thyroid hormone

Maintenance therapy

1st line:

  • lithium
  • lamotrigine
  • divalproex
  • atypical antipsychotics: olanzapine, quetiapine, risperidone, aripiprazole
  • lithium/divalproex + quetiapine/risperidone/aripiprazole/ziprasidone

2nd line:

  • carbamazepine
  • paliperidone
  • lithium + divalproex/carbamazepine
  • lithium/divalproex + olanzapine
  • lithium + risperidone or lamotrigine
  • olanzapine + fluoxetine

3rd line:

  • asenapine
  • phenytoin
  • clozapine
  • ECT
  • topiramate
  • omega-3 fatty acids
  • oxcarbazepine, gabapentin

Not supported by evidence:

  • gabapentin, topiramate, or antidepressants when used alone as monotherapy
  • flupenthixol as an adjunctive treatment


The role of antidepressants:

Antidepressants don’t always work well in bipolar disorder, and they can potentially do more harm than good.  In case you’re interested, the International Society for Bipolar Disorder has a task force report on the use of antidepressants in bipolar disorder.


And there you have it, folks.  Was there anything in the guidelines that surprised you?  And for those with bipolar disorder, how does your treatment regimen compare to what’s in the guidelines?


Full reference:

Yatham, L.N., Kennedy, S.H., Parikh, S.V., Schaffer, A., Beaulieu, S., Alda, M., O’Donovan, C., MacQueen, G., McIntyre, R.S., Sharma, V., Ravindran, A., Young, L.T., Milev, R., Bond, D.J., Frey, B.N., Goldstein, B.I., Lafer, B., Birmaher, B., Ha, K., Nolen, W.A., & Berk, M. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAD guidelines for the management of patients with bipolar disorder: Update 2013. Bipolar Disorders, 15, 1-44.


Image credit: 3dman_eu on Pixabay

3 days, 3 quotes tag – The Anne of Green Gables edition

I’ve been tagged by A Guy Called Bloke and K9 Doodlepip for 3 days, 3 quotes and tag 3.  I’m going to pull a cheat-o-rama and do 3 quotes in 1 day.  The quotes are all from Anne-with-an-e of Anne of Green Gables, one of my favourite book series when I was a child.


“I read in a book once that a rose by any other name would smell as sweet, but I’ve never been able to believe it. I don’t believe a rose WOULD be as nice if it was called a thistle or a skunk cabbage.”

“Tomorrow is a new day with no mistakes in it… Yet.”

“Next to trying and winning, the best thing is trying and failing.”


Image credit: Common Sense Media

3 days, 3 quotes

I was tagged by Beckie’s Mental Mess for the 3 days, 3 quotes challenge.  I’ve done this a few times already, so I’m going to cheat and do 3 quotes in 1 day.  All of the quotes are from Eeyore, Winnie the Pooh’s eternally pessimistic friend.  When I was young I had Winnie the Pooh wallpaper, and Eeyore was my favourite.



“No brain at all, some of them, only grey fluff that’s blown into their heads by mistake, and they don’t Think.”


Eeyore: Good morning, Pooh Bear.  If it is a good morning.  Which I doubt.

Pooh: “Why, what’s the matter?”

Eeyore: “Nothing, Pooh Bear, nothing.  We can’t all and some of us don’t. That’s all there is to it.”

Pooh: “Can’t all what?”

Eeyore: “Gaiety. Song-and-dance. Here we go round the mulberry bush.”


“I’m not asking anybody,” said Eeyore. “I’m just telling everybody. We can look for the North Pole, or we can play ‘Here we go gathering Nuts in May’ with the end part of an ants’ nest. It’s all the same to me.”


And finally, one more bonus quote that pretty accurately sums up my view of my own surroundings:

“Everybody crowds round so in this Forest. There’s no Space. I never saw a more Spreading lot of animals in my life, and in all the wrong places.”


Image credit:

Book review: If I Could Tell You How It Feels

Book cover: If I could tell you how it feels by Alexis Rose

If I Could Tell You How It Feels: My Life Journey With PTSD captures Alexis Rose’s journey toward healing from PTSD.  The book consists of narratives interspersed with poetry, along with beautiful art by Janet Rosauer.  The chapters are short, which I always appreciate since it makes it easier for readers with concentration problems, and they flow nicely.  Alexis doesn’t go into details of her trauma, minimizing the chance of triggering her readers.

Over the years Alexis has experienced severe symptoms of PTSD.  She has flashbacks which are easily triggered, and she describes the considerable effort she’s had to put in on an ongoing basis toward managing her triggers.  As she worked with her therapist she learned tools to manage her ongoing symptoms.  However, she has come to understand that for her there will be no cure and she will have long-lasting effects that will require ongoing work to manage.

Alexis describes the multitude of interpersonal challenges that go along with PTSD, from the doctor who asked why she couldn’t just get over it, having to navigate friendships, losing the people that backed out of her life and managing the walls that she put up for self-protection.  Her family has been profoundly impacted by her illness, and she describes how roles within the family have had to shift over time, requiring adaptability from all of them.

Self-stigma has been an issue, and she writes “I wrestle with feeling like I’m lazy because I haven’t cured myself of this illness”; this is something that will probably sound familiar to many of us in the mental illness community.  She describes self-doubt as an unwanted houseguest, but one that no one else can see.  When things get really hard, she has to actively remind herself that she is in the process of healing.

Alexis shares some of the valuable lessons she has learned along her journey.  She has come to understand that while PTSD impacts her it doesn’t define her, and while she was a victim she is definitely a survivor.  This resonated strongly with me, as I grappled with the term victim with respect to my own experience of workplace bullying.  Alexis talks about her struggle to establish an illness-free identity despite her ongoing symptoms; again, this is something I suspect will resonate strongly with many readers.  She has learned to set boundaries, remove toxic people from her life, and reach out and ask for help when needed.

Alexis identifies a number of strategies that have been helpful on her non-linear road toward healing.  Writing has been helpful for processing memories, and naming what had happened to her made it easier to see the bigger picture.  Radical acceptance has allowed her to find greater peace, own her past, and acknowledge the hard work she has put in.

While this book talks about the challenges of PTSD, the focus is very much on healing and learning to live your best life even with ongoing symptoms of illness, and as such readers with various other mental illnesses are likely to feel a sense of connection.  The title is very apt, and Alexis does an excellent job of capturing what her healing journey feels like and has felt like at various points along the way.  This is an inspirational book that I would highly recommend.


You can find Alexis Rose on her blog Untangled

I have also reviewed Alexis’s first book, Untangled.

A little speech 🙂

It’s not too late to get involved in Stoner On A Rollercoaster’s mental health awareness campaign.


I am giving a lot of speeches these days. this one is a thank you speech.

I will start circulating today. So I have added following part in MHA post:

I started this whole thing on a whim and the way you guys came forward to help is overwhelming. This post looks like a mini support group now for which again I am grateful for each one of you who joined in. It’s been a humbling experience overall.

Today I will start circulating through my trusted 2-3 friends outside blogosphere. I urge you share this post too.

And I would highly appreciate and recommend you reach out to each other too. That’s what helps the most at any given day.

I wont stop this effort here. I will continue to send invites, gather more fighters on random basis and keep on adding them here as long as I have energy.

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Revenge of eve G2K

It’s G2K (Get 2 Know) day over at Revenge of Eve.  Here are this week’s questions:

*Who is your hero?

My grandma

*What is their superpower?

Always keeping a positive attitude and a sense of humour.  She’s 101 and starting to dement, so she’s a bit disinhibited.  The last couple of years she’s started badmouthing her ex-husband (my grandpa) and how badly he treated her.  I think it’s awesome that she’s no longer bottling up all those emotions from so many years ago, and instead she’s just letting her rip.

*Where was your first kiss?

To be honest I don’t actually remember, although it wasn’t until I was around 19 or so.

*When was the first time you fell in love?

My first boyfriend.  I think I was 22 at the time.

*How did you know it was love?

He became my whole life.  Not the healthiest thing in the world, looking back.

*Why is love important?

The feeling of acceptance that goes along with love (or should, at least) is wonderful.

*Journal prompt: Write about your first love.

C was a bit of an ass.  We got along very well as friends, but rather than accepting me and my life he expected me to become more like him.  It took me a few years to realize that’s what was actually going on, but I’ve learned from him that I deserve to be with someone who accepts me 100% exactly the way I am.  I also learned that there is no room in my life for people who run in the other direction when I get sick.

A couple of years ago, I randomly bumped into him in a park after not seeing him for almost 10 years.  I was really unwell at the time, and barely able to string a coherent sentence together.  I made a half-assed attempt at polite small talk, but couldn’t manage it, and just turned and walked away.  My reaction bothered me because I hated the idea that he would think he had the power to upset me sufficiently so as to make me non-functional.  But such is life.

To participate:

  • Create a post answering the above questions.
  • Title your post G2K
  • Use the header image as your image.
  • Use #g2k in your post settings
  • Create a pingback linking you to this post.
  • Write the journal prompt in your private journal or on your post.

We have a message – how do we spread it?


May is mental health awareness month, and I’ve seen a lot of great blog posts related to this.  But I wonder sometimes if we’re doing a lot of preaching to the choir and not necessarily creating a lot of change in stigma on a broader scale.  I know that researchers like Patrick Corrigan have found that exposing people to individuals with mental illness is one of the most effective ways to counteract stigma.  So sharing our stories is a good thing, but how do we make sure we’re reaching people?

Facing stigma on line

When it comes to challenging stigma online, it’s my belief that we have to pick our battles, at least to some extent.  Besides the trolls who are just plain nasty, there seems to be a subset of people who actively choose ignorance and aren’t interested in being exposed to new ideas (or reality for that matter).  I always feel bad for people who get sucked in trying to educate this group of folks and end up frustrated by these folks’ intransigence.  I think our best chance of success is with people who are ignorant due to lack of exposure rather than due to head-up-ass syndrome.  So, how to find those people and how to reach them?

Anti-stigma organizations

There are a lot of organizations out there working to fight stigma.  This is useful, but there are also limits.  These types of organizations often focus on specific events or awareness-raising campaigns.  Initiatives like Mental Health Month in the United States, Mental Health Awareness Week in Canada and the United States, and Bell Let’s Talk Day in Canada can reach large target audiences, but whether that audience is actually engaging beyond a token retweet or two is debatable.  This is a dialogue that needs to happen year-round, and I think that’s where we as individuals come in.

Telling our stories

We’re the ones that really bring a human face to mental illness.  We’re the ones who show that it can happen to your parent, friend, or partner.  I really don’t know what the best way is, but probably the more different ways we communicate our message the better.  Blogging, social media, doing interviews for podcasts, speaking in-person at awareness events…  There are a lot of options to choose from, and it’s exciting to read on people’s blogs all the different ways that they’re getting their message out there.  And the more of us that are speaking up the better.  There are a heck of a lot of us out there with mental illness, and it seems hard to believe that there’s not somehow a way for us together to create huge change.

If 1 in 4 of us will experience mental illness, and we can each convince 1 person that mental illness is real, it’s serious, and it’s ok, then that’s half the world.  The ignoramuses of the world will always be there, but by ignoring them we will have more energy to focus on getting the word out to the people that have the brains to listen.  So let’s keep talking.


Image credit: OpenClipart-Vectors on Pixabay

20(ish) Questions

pile of question marks

I’ve decided to take a bit of a break from blog awards, but when I’m nominated for awards I’ll answer the questions posed to me in this 20(ish) questions format.  I’ll also throw in assorted question tags ands the like.  Feel free to join in the fun with your own answers to any or all of the questions 🙂


Questions from A Guy Called Bloke and Doodlepip’s Adventures

  • How DO YOU fold a fitted sheet?  With a great many swear words.
  • What is REALLY meant by the phrase ‘Love is in the air?’  Aerosolized chlamydia perhaps?
  • What was the weirdest, strangest and most mysterious phone call you ever took or made?  I feel like I should have a good answer to this, but I don’t.  The other day I had a call show up on my call display as being from Malaysia.  That was pretty random, but I figured it was some kind of scam thing so didn’t answer.
  • This is a real mystery – would you rather be ugly as sin and live forever or look as attractively sexy as was possible, but die in a year?  I don’t want to live forever regardless, so I pick die in a year even if it was combined with ugly as sin.
  • Ok, ok, here’s the cliff hanger – you are offered £$/100,000 to eat a bowl of mixed bugs – you know crunchy mealworms, slimy earthworms, buzzing crickets, wrinkly woodlice and moist maggots and the list goes on – would you eat it and be richer or not?  I am going to do the world a favour and not pass on the pictorial adventure that Rory included in his post…  But anyway, no.  I’m not in sufficiently dire need of money that I could be convinced to go for that.

More from A Guy Called Bloke from round #4 of his quick fire series

  • What Makes Us, Us?  I think my guinea pigs would say it’s how we smell.
  • What’s the best thing to have happened in your day so far?  The sun is shining.
  • We say no regrets, but we all have them. is there something in your life that you regret not doing?  Too many to pick one.
  • Ok, the heroes are handing out super powers, what’ll you pick for yourself?  The ability to eat cheeseburgers and cheesecake frequently with no negative consequences.
  • Fess up, if walking down the street at night and people’s curtains are open and the house lights are on, do you take a furtive glance in?  Why furtive?  I’d say go for the full-on stare.
  • What is one word that defines your personality to a tee?  I would go for a tee-(shirt) that says Back The Fuck Off.  It’s more than one word, but I’m ok with that.
  • What is your biggest fear?  Being totally alone with no money and the only food option was the bowl of mixed bugs.
  • Age old question, but if the words you spoke appeared on your skin, would you say half the stuff you do?  I would probably say nothing at all, except perhaps expletives.
  • Ok, ok, you are back at school, and the the groups are looking for new members, what clique would fit you well?  Eww, yuck, now there’s an awful thought.  I guess whichever was geekiest.
  • What is your best music genre of all time?  80’s pop
  • You find yourself with a difficult decision – you are to be abandoned on an island in the middle of nowhere and are allowed five items only – what do you take and why?  So I’m assuming there’s no wi-fi in the middle of nowhere…  In which case, paper, pen, toilet paper, matches, and marshmallows.
  • How do you spend your free time?  On my computer writing and reading blogs
  • How many hours sleep a night do you need?  8-9 optimally
  • How many hours sleep a night do you actually get??  Usually 5-7.
  • If you were in an ultimate position of power and the leeway to do three profound things – what would you do?  Since absolute power corrupts absolutely, probably something not very nice.  Perhaps banish stupid people to an island with nothing but bowls of bugs to eat…
  • Have you ever danced in the rain or tangoed in Paris?  Neither, alas, but maybe I need to rethink my bucket list
  • What question do you most positively, absolutely hate to answer?  Anything related to what I do for work.  Refer back to the Back The Fuck Off t-shirt.
  • What are three of your most favourite words?  onomatopoeia, cockamamie, and   a new favourite is hippopotomonstrosesquippedaliophobia
  • What are three of your least favourite words?  panties (I don’t know why it bugs me so much, but it does) and words used by young whippersnappers these days that make me feel old because I don’t know what they mean, like “lit” and “woke”.


Questions from Topics With Passion:

  • Why did you start blogging?  I had quite a bit of time on my hands and was feeling aimless, so I thought blogging would be therapeutic.  And it has been!
  • If you won the lottery, what is the first thing you would do?  I don’t know that I’d do anything right away.  Right now there’s nothing buy-able that I can see creating a major positive change in my life.  I’d be more interested in saving it so I’d have long-term financial security.  Yes, I’m boring, and I’m okay with that 😉
  • What is the worst purchase you ever made?  Not sure, but maybe the ski pass I ended up hardly using at all.  Or the cumulative amount of clothing I bought and rarely wore.
  • If you were given a one-minute ad slot during the Super Bowl that you couldn’t sell, what would you fill it with?  Guinea pigs playing.  Guinea pigs dancing while riding on the backs of llamas, followed by a yak doing the funky chicken.
  • What fictional place would you most like to go?  Green Gables, as in Anne of Green Gables.  I loved how creatively she named all the little backwoods nooks and crannies.


Come on, you know you want to answer a few – that’s what the comments section is for!


Image credit: qimono on Pixabay

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I’ve been coughing up a lung all week trying to get rid of thick phlegm left over from my respiratory tract infection last week.  I’m very much ready for this to be over and done with.
  • I made some changes with my internet and tv service about six weeks ago, and my service provider has screwed it up at every possible step along thr way.  I was talking to them yet again via internet chat this week, which resulted in me crying and terminating the chat session.  I hate that it’s so hard for me to deal with things that are annoying but in the grand scheme of things pretty inconsequential.
  • I was able to get more reading done than the goal I’d set for myself for the week.
  • I had a massage and went to yoga once.  I’ve also decided to have a splurge week of eating simple but yummy foods, like baguette and brie for lunch.
  • I’ve found myself jumping to illogical conclusions more than usual this week, but at least I’m not clinging on to them too tightly and after a bit of thought I can recognize that these ideas aren’t reasonable.
  • it’s been 4 weeks since I planted my little herb garden on my balcony, and there’s been no sprouting action going on yet.  I have no idea if this is normal or just my usual plant-killing self at work.
  • I didn’t work a lot this week, but what I did went reasonably smoothly.
  • I’ve had a bit of a blogging existential crisis.  I’m not sure exactly what started it, but there were a couple of things I can think of that certainly didn’t help.  I think in my head I started to stray a bit from my purpose and how I want to approach blogging, which triggered some insecurity and all that jazz.  I’ve identified a few ways that could help me refocus, and that seems to be working well.
  • It’s interesting how hearing particular words can be a good thing most of the time, but a not good thing depending on the person or situation.  I won’t go into detail, but I’m feeling disappointed.


How has your week been?


Image credit: Rawpixel on Pixabay

Stories of Mental Illness-Ashley’s Story — Midsummer Daydreamer

photo courtesy of PixabayDepression: Ashley’s Story I was first diagnosed with major depressive disorder more than 10 years ago. Over the years it’s had a significant impact on my interactions with other people. Some people have been really supportive, while other people have passed judgment on me because of my illness. Like Heather I’m a…

via Stories of Mental Illness-Ashley’s Story — Midsummer Daydreamer

What I’ve gained from my mental illness

woman holding out a white rose

I’ve read before that mental illness should be viewed as a gift, and while that struck me is a big fat load of BS, it did prompt me to give some thought to things that I have gained from my illness:

  • greater empathy and compassion
  • greater understanding of mental illness
  • makes me a better nurse
  • has helped me to be less judgmental
  • has made me more open-minded and accepting
  • has given me a greater appreciation of wellness, happiness, and hope
  • it inspired my masters thesis and several published academic papers
  • it has put me in a better position to challenge stigma
  • it has allowed me to access a sense of community and belonging among mental health bloggers
  • it has pushed me to take a closer look at my thoughts and emotions
  • it has made me take a more holistic view of managing health problems in general

What have you gained from your mental/physical health challenges?


Image credit: Photo by Annie Spratt on Unsplash

Mental illness and the dreaded job interview

woman preparing for a job interview

Job interviews are unpleasant at the best of times, and to me have always felt very fake.  But throw mental illness into the mix, and they can be a huge obstacle.  There are a number of aspects of job interviews that particularly worry me.

Answering unexpected questions

My cognitive symptoms of depression aren’t as bad now as they have been, but my brain is still pretty slow to react to anything unexpected.  Even in low-pressure situations I may be asked a question and I just can’t generate an answer.  I may make light of it and brush it off as oh, brain fart, I lost my train of thought.  In a high-pressure interview, my mind would go blank, and that would make me anxious, which would further ensure that my mind would stay blank, and I would be left staring stupidly at the interviewer.

Having to identify positive examples

I can identify some positive things in my past and present, but put me on the spot and the only things that my mind can find are negatives.  Throw in that my memory is not that great, and I would be waiting/begging for the ground to open up and swallow me.

Having to sell myself

I’ve always thought it felt rather fake trying to convince interviewers that you’re amazing and wonderful and all that crap, because it always seems like there’s things you’re expected to say and not say.  It’s tough even when I believe that I actually am pretty wonderful.  Now?  Well, I know that I have my strengths, but the idea of trying to self myself to someone makes me want to barf.  I have to work hard at trying to shift focus to genuine positives, and trying to portray a prettily wrapped fake package of trite expected positives sounds pretty close to impossible.

Questions about interpersonal things like dealing with conflict

I hate people.  I like my fellow bloggers, and I like my patients, but otherwise I pretty much hate people in general these days.  That hasn’t always been the case, but the combination of depression and having experienced workplace bullying have pretty much soured me on humanity.  So there’s that.  Then there’s avoidance, the coping mechanism I’ve had to rely on far too often to extricate myself from situations I don’t have the resources available to cope with.  So when faced with the inevitable interview question about how I handle conflict, I can hardly say I run as far away as I can as fast as I can to hide out in my cave away from people, who, by the way, I hate.  Can’t talk about being bullied, either, because that’s not considered acceptable.  Obviously I would need to lie.  Depression makes me very good at lies like “I’m fine” or “I’m okay”, but makes me very bad at crafting (and remembering) more elaborate lies.

Having to answer questions about gaps in my resumé

I quit a job because I was bullied.  I was unemployed for 9 months due to lasting effects of the bullying.  One of my current jobs, the one in mental health, I think I’m going to leave off my resumé entirely.  So there’s holes, and in my experience interviewers tend to be nosy buggers, so they want those holes filled in or the application goes straight in the recycle bin.  Except neither bullying nor mental illness are “acceptable” excuses for resumé holes.  So what, more lies that I’d have to pull out of my ass that is getting sorer by the minute?

Managing anxiety

Interviews are anxiety-provoking for anyone.  Anxiety isn’t a huge part of my depression,  but not surprisingly it gets amplified in high-stress situations, and my brain runs in circles but doesn’t move forward.  So then it’s a matter of figuring out a pre-medicating strategy; enough Ativan and/or Seroquel to tone it down without turning me into a drooling zombie.

Managing triggers without either crying or completely shutting down

There was one interview I did while I was depressed, and I don’t remember if it was something the interviews said or the way they said it that triggered me, and I started crying.  I couldn’t stop, so I just got up and walked out.  Not surprisingly I never heard from them again.


Mental illness is hard enough without having to concoct BS stories to appease potential employers who are bursting at the seams with stigma.  Even employers who are more progressive are likely to have an easy time coming up with excuses not to hire someone who has a hard time explaining away the effects of their illness on their work history.

Has your illness impacted your search for work?


Image credit: FotografieLink on Pixabay

What scares me

eyes showing fear

I came up with this list as part of my bullet journal.  I feel like there should be a lot more things on it, but this is what has jumped into my head thus far.

  • never getting well
  • not being able to get another nursing job
  • being forced to move for financial or other reasons
  • not having enough income to get by
  • losing my extended health insurance
  • having another failed suicide attempt
  • losing my independence
  • rejection
  • invalidation
  • not having anyone I feel safe with
  • being completely alone
  • and on a lighter note, various creepy crawlies that I’m not interested in naming


What scares you?


Image credit: ghwtog on Pixabay

Book review/rant: Lost Connections

Book cover: Lost Connections by Johann Hari

In Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions, Johann Hari takes a stand against the idea of biological causation of depression and anxiety.  I expected going in that this book would annoy me, but at times it was just plain ridiculousness.

To start off, let me tell you the perspective I’m coming from.  I support a biopsychosocial model that recognizes mental illness as complex and often multifactorial.  Every individual’s illness stems from a unique combination of factors, and for a treatment plan to work best it needs to effectively target whatever contributing factors can be identified.  Sometimes that’s meds, sometimes that’s psychotherapy, and more often than not it’s a combination of multiple different strategies.  Meds aren’t a miracle cure but can get you well enough to do whatever it is you need to do to find true wellness.  Ok, now that we’ve got that out of the way, let’s jump headfirst into the book.

Red flags were set off for me early on in the book when the author wrote that at age 18 he had an epiphany that he had the medical condition called depression, and from information in the media he knew that antidepressants were just what he needed to quickly make him all better.  Initially he was convinced paroxetine made him feel even better than simply not depressed, and he spread the word to others that depression was solely about serotonin and antidepressants were the best thing since sliced bread.  Years later, his therapist pointed out to him that it seemed like he was still depressed; the author responded that no, he couldn’t possibly be depressed because paroxetine was keeping his serotonin levels up; but then changed his mind and decided to stop meds.  “It was only when I stopped taking the [SSRI] and I started having more pleasurable sex again that I remembered regular sex is one of the best natural antidepressants in the world.”  I guess I’m just a little (or a lot) judgmental, but this dude seemed like he was energetically leaping onto the train to out-there-ville.

toy train

Next stop on that train is with researcher Irving Kirsch.  Kirsch criticized the typical design of drug trials, i.e. randomized placebo-controlled trials (you can find more about that in my post on research literacy).  He argued that to truly understand the effect of a drug there should be 3 arms to these kinds of studies: drug, placebo, and no-intervention, with the third arm capturing the number of people who get better with no treatment or placebo at all.  This sounds all well and good except that it gives you zero new information about what the drug does.  The people who would respond to no intervention are already captured in the placebo responders, so adding a do-nothing arm only gives you information about how much of the placebo effect is due to that sugar pill the researchers are giving the patients.  Now that information may be useful in examining the placebo effect, but it doesn’t in any way change what a study shows about the effect of drug response over placebo.

Next stop on the train is holding up the old serotonin deficiency hypothesis for depression as evidence that the illness doesn’t have a biological basis.  That hypothesis was originally developed to try to explain why drugs that blocked serotonin reuptake had an antidepressant effect, and at the time they didn’t have the scientific techniques available to test whether this was really accurate.  It has since become clear that depression is not related to a deficit in the absolute amount of serotonin, but that doesn’t mean we should throw the baby out with the bathwater.  Just because the overly simplistic early explanation was wrong doesn’t mean that neurotransmitters have nothing to do with depression period, and it doesn’t mean that antidepressants that affect neurotransmission won’t work.  It’s like saying that because the flat earth hypothesis was wrong there must be no earth at all.

The author talked about bereavement being mislabelled as depression.  A woman he interviewed said “So now if your baby dies and you go to the doctor the next day and you’re in extreme distress, you can be diagnosed immediately.”  People have the right to be ignorant, but that doesn’t mean their ignorant comments should be thrown into a book as evidence.  This idea that the DSM diagnostic criteria are a checklist and if you tick enough boxes you must be labelled with the disorder, well, it’s just not correct, which is why only highly trained clinicians are qualified to diagnose.  Admittedly, some clinicians are too quick to jump to a diagnosis, but that’s very much a separate problem.

In the DSM-IV, bereavement was listed as an exclusion criteria for diagnosing a major depressive episode; this was done in an attempt to avoid bereavement from being mistaken as depressiom.  The author raised concerns that maybe depression wasn’t so sound an entity if a normal experience mimicked the symptoms.  But then he does a 180 and questions the removal of that bereavement exclusion in the DSM-5 and the addition of only a “vague footnote”.  That “vague footnote” is actually part of diagnostic criterion C for a depressive episode, and says: “Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.”  So yeah, no day-after-death diagnosis.

toy train

The author announced that based on his information gathering (and no training whatsoever in psychiatry/psychology) he has identified 9 causes of depression.  He adds that depression is a form of grief over these various forms of disconnection.  The identified causes are:

  1. Disconnection from meaningful work
  2. Disconnection from other people
  3. Disconnection from meaningful values:  The author talked about “junk values”, and particularly materialism, as being problematic and something he had struggled with.  It was around this point that it really started to sound like the author was referring to depression and anxiety as negative emotional states and existential malaise and not necessarily appreciating the difference between these emotion states and mood/anxiety disorders.
  4. Disconnection from childhood trauma
  5. Disconnection from status and respect
  6. Disconnection from the natural world
  7. Disconnection from a hopeful or secure future
  8. The real role of genes and brain changes: The author saw 2 potential roles for biology: circumstances can cause brain changes that accelerate the problem, OR
  9. genetic variations may contribute to depression but only in specific environmental circumstances; they can’t cause depression without an environmental trigger

Part II of the book, “Reconnection: A new kind of antidepressant”, looks at ways in which people can reestablish those needed connections.  This starts off with what to me seemed to be a rather rambling story about an apartment block in Berlin slated for demolition.  An older woman had posted a note saying she was going to kill herself because she’d be losing her housing and she had no other options (there’s no indication that this was a woman with any history of mental illness).  This sparked community activism that positively impacted all of those involved.  And lo and behold, the woman’s suicidal thinking disappeared – so that’s what I must have been missing those times I tried to kill myself!  It made me think of a line from a medical historian interviewed in the documentary The Age of Anxiety: “If your problem can be corrected by a new boyfriend or a cheque for $5000, you probably don’t have a psychiatric disorder.”

The author came to the conclusion from this and other examples that “if you want to stop being depressed, don’t be you. Don’t be yourself.  Don’t fixate on how you’re worth it. It’s thinking about you, you, you that’s helped to make you feel so lousy. Don’t be you. Be us. Be we. Be part of the group. Make the group worth it…  So part of overcoming our depression and anxiety—the first step, and one of the most crucial—is coming together.”

The author says that “work is essential”, which made me wonder why he has his head up his privileged ass.  He talked to a woman who was anxious because of her negative work situation, then she joined with her husband and others in creating a cooperative bike repair business and things were hunky dory.  The author describes this “recipe for mental health” as “Elect Your Boss”.  So that’s what we’re all doing wrong…

toy train

Hari wrote that if he could speak to his younger self, he would say: “You are not suffering from a chemical imbalance in your brain. You are suffering from a social and spiritual imbalance in how we live. Much more than you’ve been told up to now, it’s not serotonin; it’s society. It’s not your brain; it’s your pain… Because you are being told depression and anxiety are misfirings of brain chemicals, you will stop looking for answers in your life and your psyche and your environment and how you might change them. You will become sealed off in a serotonin story.”  I suspect there may be some funky paint fumes going on up in that serotonin story.

If this had been a book about general dissatisfaction and unhappiness in society at large, I would be writing a very different review right now.  I suspect that Hillary Clinton and some of the other well known people who have commented positively on the book may have been looking at it from that perspective.  If the book had talked about some people having mental illness that is heavily influenced by social/environmental factors, or the need to take social/environmental factors into account in approaching the treatment for mental illness, then I would have far more positive things to say.  But that’s not the case.  He is saying that mental illness is not biologically caused and medication is not a valid treatment for depression.  Full stop.  I think that’s just as bad as the purely biomedical stance that he criticizes.  Such a reductionistic approach really isn’t useful to anybody, and is insulting to those of us living with the complexity of mental illness.

So what can I conclude personally from this book?  Apparently to get better I’m supposed to engage in local activism, participate in a community garden, start a co-op, hang out in nature, and get laid.  Forget meds, give me a little penis therapy instead.  Why would anyone be suicidal when they could bond over community activism?  Of the various disconnects that he believes cause depression, I had a whopping none of them for my first two depressive episodes.  Screw pain, I was generally happy and optimistic, and had no childhood trauma, a supportive social circle, a job I liked, a strong preference for the value of travelling the world rather than accumulating possessions, a home in an urban oasis right with a forest just steps away… and yet there I was, depressed, psychotic, suicidal.  Meds are certainly not the only tool in my toolbox, but without them, I probably wouldn’t be alive today.  So rather than go postal on the author’s ass for presuming to tell me what’s going on with my illness, I’ll just wave as he goes by on the train to out-there-ville.  Enjoy the ride!


You can find my other book reviews here.

Image credit: Amazon, OpenClipart-Vectors on Pixabay