This Fourth of July ...

Our Founding Fathers were a highly fractious bunch with radically different visions of what a United States of America should look like, but the one thing they had in common - they were smart. Dumb was not going to cut it. Check out the names: Adams, Franklin, Jefferson ...

George Washington, who was putting together an army outside of Boston at the time the Declaration of Independence was ratified, was acutely conscious of the fact that he lacked both the intellect and polish of his contemporaries gathered in Philadelphia, but possessed the wisdom and humility to know his place.

Washington not only respected smart, he nurtured his own whiz kids, including the brilliant field generals Nathaniel Greene and Benedict Arnold (the best general on both sides), and aide de camp Alexander Hamilton, who would later mastermind his highly successful Presidency.

Virtually all of the mess we are in today can be attributed to dumb and the culture of dumb. Where smart does exist, we have tended to squander this rare and precious resource in pursuit of dumb agendas. Only smart in the service of smart is going to bail us out of the state we find ourselves in today. Dumb is not going to cut it.

This Fourth of July ...

Let's remember what this country was truly founded on. Let's celebrate smart.

Rerun - Making Peace With Our Families and Loved Ones

Taking a brief break from work. Following is a rerun of a piece I posted in Jan:

At least half of the correspondence I get from readers comes from loved ones, including family members and sweethearts. Without exception, they are at a loss and their stories are heart-breaking. They are the innocent bystanders of our illness.

I've also had ample opportunity to listen to loved ones at various mental health venues, plus I am forever engaging them (or, rather, they are engaging me) in conversations in coffee shops, on public transport, everywhere. More recently, by virtue of a broken marriage to a woman with bipolar, I've have had an opportunity to sit in with a DBSA-run friends and family support group.

Believe me, our loved ones see our illness far differently than we do. We may complain that they don't understand us, but far too many of us fail to recognize the horrible abuse we have put them through.

Believe me, to live with a person with a mental illness is to live in an abusive relationship. Until we own up to this hard cold truth, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

I cannot disclose what takes place in our friends and families group, but I can mention this much: A father was in tears, at the end of his rope. I felt I needed to jump in, but as a patient. We put you through hell, I said, or words to that effect. But you are the best thing we have going for us. We can't do it without you ...

I noticed the look on his face. I noticed the others in the room were listening intently. No doubt, they had heard this before, but from fellow family members. What made my little homily significant was that this time the words were coming out of the mouth of a patient.

At last, came the thought, someone who understands.

Understanding. Isn't that what we are all looking for?

Much more in future blogs, including what loved ones need to know about us ...

Homeward Bound

It’s 2:45 PM. I’m at Hartford-Springfield Airport. In a half-hour I board for Baltimore-Washington, thence to San Diego. I’ll arrive in San Diego late evening Pacific Time, then head 40 miles east and 3,500 feet up where I expect to fall asleep in my own bed some time around midnight.

I’ve been on the road for a week, first to a bipolar conference in Pittsburgh, then a family visit in central CT. Tomorrow I expect to spend the day doing nothing. Ahh, nice thought.

For now, over and out ...

Pittsburgh Reflections

It’s almost 5 PM. I should be flying out of Pittsburgh right now, but - wouldn’t you know it? - my plane is not in the gate.

I cut out of my Bipolar Conference early for this?

A few observations on the International Conference on Bipolar Disorder:

I attended my first conference in 2001. Then, the brain science was only mentioned peripherally and speculatively, and the brain science posters strictly concerned size and structure rather than function and connectivity. The meds researchers were the stars of the show, and for very good reason - a lot of what we take for granted now in prescribing meds was emerging knowledge back then.

For instance, Gary Sachs of Harvard spoke about the NIMH-underwritten STEP-BD real world clinical trials that would be getting underway. That study, which yielded a lot of valuable information, wrapped up two or three years ago. Clinical trials results tended to dominate the posters sessions.

On the other hand, some things stay the same. There was a lot of talk back then about the safety and efficacy of using antidepressants to treat bipolar. With a lot more knowledge now, opinion now leans on the side of “No,” but the debate is by no means closed.

(Boarding call. ... I’m back, cruising over western PA, en route to the east coast.)

Significantly, Robert Post, then of the NIMH, disclosed new findings from the Stanley Foundation Bipolar Network that revealed that although mania gets most of the attention in bipolar, our population is depressed three times more than it is manic. Knock me over with a feather. Everyone else in the room, too.

A completely new and controversial topic was child bipolar. One of the presenters acknowledged the issue wouldn’t have even come up two years ago. Barbara Geller of Washington University (St Louis) reported on a study she was about to publish showing that bipolar kids are sicker than bipolar adults. Two major differentiating features from ADHD, she reported, were grandiosity and risk-taking.

Fast forward to 2009. The brain scientists are the stars of the show. Thomas Insel, head of the NIMH, tells the conference in so many words that bipolar research is starting to catch up to other fields. Husseini Manji who now works for Johnson and Johnson and had spoken before at the conference, talks about how things work at the cellular level while Mary Phillips (another return speaker) connects the dots at the systems level and Nick Craddock of Cardiff University reports on a gene that affects calcium channel function in a small segment of the bipolar population.

(Bear with me. We’re approaching Baltimore-Washington. Time to stow my laptop. ... I’m eating diner food in the terminal, waiting for my connecting flight to Hartford. To continue ...)

The brain science posters are starting resemble an illustrated owner’s manual to how our mind actually works (or fails to work). Hardly any industry sponsored drug trials. I spend a good 20 minutes talking with a researcher about the significance of one of the lit up areas from the functional images on display. It’s too soon to draw conclusions, but it looks like we can show the circuitry that makes bipolars over-react to both reward and disappointment. In the same area of the brain? I’m asking. Two opposite effects? Holy crap!

Meanwhile, at other posters, the first results of a longitudinal study tracking 400 bipolar kids are starting to roll in. The study is going to tell us a lot about the course of early onset bipolar, and whether it turns into adult bipolar over the years. Unlike eight years ago, virtually no one here is questioning the diagnosis. Instead, the debate is over achieving a consensus on the diagnostic fine points.

Of course, the more we find out the more we realize how ignorant we are. Moreover, in the real world, patients would be hard-put to point out any personal benefits from new scientific discovery. Quite the contrary, services have significantly deteriorated over the years while the new-generation meds have failed to live up to their promise, which has set off a justifiable reaction.

You’ll have to trust me on this: The difference between my first conference and the one I just attended is night and day. Mind-boggling findings are coming in thick and fast. Perhaps our generation will only achieve a marginal benefit, but be assured - future generations will be spared a lot of our suffering. It was my privilege to be talking to the people who have dedicated their lives to making this happen.

Time to board my flight. This is John McManamy. Over and out ...

From Pittsburgh: Awards Night

It’s past 11 PM. I just got back from an awards dinner at the Eighth International Conference on Bipolar Disorder in Pittsburgh. This particular dinner is special to me. Allow me to explain:

The Conference honors the memory of Mogens Schou, the late Danish psychiatrist who pioneered lithium treatment in the 1960s, which revolutionized psychiatry and offered hope to millions. Each meeting, the Conference singles out individuals for outstanding achievement in three categories: Education and Advocacy, Research, and Public Service. The Mogens Schou Award is recognized as the highest honor one can attain in the field of bipolar. Past recipients have included Mogens Schou, Kay Jamison, and such paradigm-shifting researchers as Husseini Manji.

At the previous meeting, two years ago, I received the Mogens Schou Award for Public Service. I could say a number of things, but let’s leave it at the fact that I was flabbergasted, humbled, and honored.

This year’s Mogens Schou Award recipients:

Lakshmi Yatham, for Education and Advocacy: Dr Yatham of the University of British Columbia, through various leadership positions including president of the International Society for Bipolar Disorders has been instrumental in improving treatment and diagnostic standards within the medical profession and amongst the general public.

Guy Goodwin, for research: Dr Goodwin, of Oxford University, has been involved in research into the neurobiology of bipolar and psychopharmacology, including developing the basis for large scale and low budget real world clinical trials, including BALANCE, which you will hear a lot more about fairly soon.

Joyce and Dusty Sang, for public service: In 2004, the Sangs, who have a lifelong commitment to public service, created the Ryan Licht Sang Foundation which has fostered awareness, understanding, and research for child and adolescent bipolar.

At the first available opportunity, I introduced myself to the Sangs and told them how honored I felt that they received the Award. We instantly connected. The Sangs got involved through the suicide of their only child, Ryan, age 24. Joyce pinned a Foundation lapel pin on my jacket, which I will continue to wear in memory of their son and as a tribute to their work.

I found my voice catching several times in the conversation.

As I said, this particular dinner is special to me.

Tooting from Pittsburgh - More Brain Science

Above is an illustration of the brain showing the circuitry that is attracting the attention of researchers across just about all fields of mental illness. This PowerPoint slide comes from a talk given at this morning's session at the Eighth International Bipolar Conference in Pittsburgh by Hilary Blumberg of Yale.

What you are looking at is two-way traffic between the reactive/arousal amygdala and the thinking/modulating cortical areas. Abnormalities in these circuits has been implicated in all manner of mental illnesses. Essentially, when things go wrong, the emotional amygdala is shouting too loud and the rational cortical areas fail to reassert control.

Below are two fMRI images of a bipolar brain in action, from a study currently in press. These slides were presented at the same session by Mary Phillips of the University of Pittsburgh. What we are observing are top down images of the two-way traffic between the amygdala and the orbitomedial prefrontal cortex. On the left side, in a normal reaction, you see evidence of heavy and direct traffic while the smaller arrows to the right indicate lighter traffic.

In the bottom image, the denser arrow to the right notes an over-reaction, which shows up in bipolar subjects, but is not in evidence in healthy control subjects or in unipolar depressed individuals.





























In yesterday's blog, we were looking at brain dysfunction on the "cellular level". Here, we are viewing the things that can go wrong on the "systems level". Using brain imaging, Dr Phillips has been able to distinguish between unipolar and bipolar. Dialing in the research further promises to further sharpen our diagnostic capabilities.

I asked Dr Phillips about this. On previous blogs, I showed brain scans of similar breakdowns in the circuitry between the back and front areas of the brain in patients with borderline personality disorder, a very similar picture to what you are looking at now. It's only a matter of time before we can use brain scans to separate out borderline from bipolar.

These are exciting times. John McManamy, live from Pittsburgh ...

Tooting from Pittsburgh II

It's going on 10 PM. I'm just about to get some serious sleep after a full day at the Eighth International Conference on Bipolar Disorder taking place in Pittsburgh. The image comes from a PowerPoint presentation in a morning talk by Husseini Manji on the fine points of BAG-1, a protein which seems to prevent glucocorticoid receptors from migrating to the nucleus of the neuron, if you know what I mean.

Let's put it this way, when glucocorticoid succeeds in its migration bad things happen.

It was heavy duty on the brain science this morning. We're not talking "imbalance of chemicals of the brain," Dr Manji reminded his audience. Instead, think of mood disorders as "impairments of synaptic and neural plasticity."

Don't worry if you don't understand any of this. I'm just giving you a feel for how my day went. Take my word for it, this is brain science 6.0. I'll be better able to break it down for you when I have a clear brain. To bed ...

This is John McManamy, live - well, actually brain dead - from Pittsburgh.