I am back home in New Jersey. My five-month conference season is formally over. Since the end of April, I have been away one day in five. I saw a Mountie, heard bagpipes, and discovered the 60s. I got to talk with the leading bipolar researchers and clinicians, as well as to people who happen to be experts by virtue of having to live with their illness day to day. I picked up information on everything from the fine points of brain science to nuances in the mood spectrum to treatment strategies to how to better facilitate a support group.
I entered the conference season in my baseline introvert mode and ended it literally tap dancing. Some highlights:
Strongest theme to emerge – About 40 percent of us don’t take our meds as prescribed. Speakers at the American Psychiatric Association annual meeting in Toronto, the NAMI convention in Washington DC, and the International Society of Bipolar Disorders conference in Edinburgh tackled the issue from all sides, but it all boiled down to University of Pittsburgh’s Holly Swartz MD’s pithy statement: "If a patient doesn’t stay on it, it doesn’t do any good, even if it works.”
Hottest part of the brain – The amygdala, in the limbic system, responsible for the fear response. The experts everywhere are talking up the amygdala bigtime. The fear response underlies our anxiety, but increasingly researchers are also finding it plays a central role in mood. Take home message: Work on your fears (say through cognitive therapy) and learn to manage your stress.
Hottest three neurotransmitters – Dopamine, dopamine, and dopamine. The amygdala does a lot of talking to the rest of the brain via dopamine. Dopamine plays a key role in pleasure and reward, as well as cognition. Getting a better read on the brain’s dopamine system is one of the keys to better treatments and a healthy life.
I knew it all along issue – The mood spectrum. Depression, mania, psychosis, anxiety, and behavior are not separate phenomena. They all overlap and interact. The leading experts have known this for years. Now every psychiatrist on the block is acting as if he or she has learned this in first year med school. The mood spectrum has arrived. Time to revisit the DSM.
Weirdest conference moment – Talking to a Scientologist just outside the NAMI convention venue. Their church happened to be located only a block or two from the convention hotel. “Ron Hubbard used to have an apartment around here,” a chirpy acolyte enthused, as if pointing out Lincoln’s birthplace.
Second weirdest conference moment – Showing up with my fruit at an antipsychiatry pot luck dinner in Beserkley. Antipsychiatry is kind of like Scientology without the volcanoes. We badly need an in-your-face movement to keep psychiatry and the drug companies honest, but the people carrying the banner are living in the past and sorely out of touch with those of us focusing on our recovery.
Biggest jerks – The drug company reps, no question about it. Think of the bullies on the football team who made your life miserable in high school. They all grew up to be drug reps. At the APA annual meeting they were everywhere. If you want to know who is at the bottom of the mental health food chain and who is at the top, just go one on one with one of them. Ten seconds into the conversation and you will start thinking the antipsychiatry people make a lot of sense.
Most moving conference moment – Sitting at a table with a founder of NAMI. She is a mother caring for a 40-something son with severe mental illness. The son joins us at the table. What will happen to him when his mom can no longer care for him? I feel a mixture of both sadness and rage. I can only imagine what the mother must feel.
Light bulb going off in my head moment – Author Judy Eron asking me over breakfast at the NAMI convention what formal arrangements my wife and I have in place should one of us need to make the executive decisions for the other. Uh, none, actually. Holy crap! At the DBSA conference I tell Judy that my wife and I now have a dialogue going, and thank her profusely for the wake-up call.
Best sound bite – Washington state politician and DBSA board member, Randy Revelle, recalling at the DBSA conference his first experience advocating for mental health parity. At a hearing, he held up in one hand his meds for his digestive complaint, fully covered by his health plan, and in the other his bipolar meds, not fully covered. Then he said: “My health plan thinks my [rear end] is more important than my brain.”
Most pleasant surprise – “To be honest, I’d rather be going to a conference in Pittsburgh,” I tell my wife as I head out for Edinburgh. I wind up falling in love with the city and escaping the worst of the east coast’s ferocious and unrelenting heat wave. My wife is ready to kill me when I tell her over the phone I had to buy a sweater.
Most in character moment – I tape three dollars worth of quarters to my sneakers and do a tap dance at the DBSA talent show. Crazy is good.
Why I need to go to conferences – “I should have known that four years ago,” I tell a psychiatrist at the APA annual meeting in reference to what a speaker said at the previous session. It turns out I have an awful lot of “should have known” moments. My consolation is that these speakers are talking to the very people we entrust out lives to, who are also hearing a lot of this stuff for the first time. This illness takes no prisoners. We have to be as smart as the people who treat us. We keep learning because we have to. It’s that simple.
Moments to live for – Rekindling old friendships, forging new ones. The very first conference I ever attended was the 2000 DBSA conference in Boston. I sat down next to Angela Vickers and tentatively introduced myself. Angela is a tireless advocate, a tiny woman with a larger-than-life personality, and we would keep running into one another at various conferences, strengthening our bond. It had been nearly three years since I had last seen Angela. It was positively joyous meeting up with her again at this year’s NAMI convention. The hypomania level in the group of people I was with went way up. No one at the NAMI convention was going to mistake us for family members. At dinner, the champagne flowed without the champagne. At some future conference, Angela and I will meet up again, and the champagne without the champagne will flow. Can’t wait.
Published On: September 25, 2006
Living With6 Chronic Condition Guidelines to Live By
Facing the challenges5 Rules for Bipolar Relationships