The book is divided into three contrasting sections. The first part is the author’s personal account of her psychic experiments, which developed seamlessly into psychosis without her noticing. The second part is her mother’s account of the author’s hospitalizations, and her denial and final acceptance of her mental illness. Part three contains sections from Jacobs’s diaries, written at the time of her psychosis, as well as clinical and legal documents relating to the same period.

Jacobs was born in Christchurch, New Zealand, in 1965. Throughout her childhood, though she had loving and close relationships with her parents and siblings, she was tormented in school about her weight. After leaving school, she worked in banking for several years, then traveled to Europe to broaden her experience. Recovering from a broken relationship, she enrolled in law school. After graduating in 2005, she set up independently as a family barrister.

Three years later, her business was thriving, yet Jacobs suddenly found herself pining for her deceased grandmother. The loss of her loved one led her to Don’t Kiss Them Goodbye, by psychic medium Allison Dubois. After reading the book, Jacobs began to feel her grandmother’s presence, and to notice other spiritual signs. Within months, she was experimenting with a crystal ball, in which she began to see images and words that were to have a profound influence on her life. It was only a short time before she began to hear the voices of her spirit guide, Wes, initially pleasant and helping her through life.

As time went by, Jacobs began to believe that many of the people around her were actually spirits that had passed over. She lost the ability to distinguish between fantasy and reality, yet somehow managed to get through her daily routine as a barrister. As she plunged deeper into psychosis, she spent more and more time communicating with her “spirit friends,” who included Heath Ledger, Princess Dianna, and Albert Einstein. Her world was now comprised of overlapping layers where real people and her imaginings were distinguishable only by their means of communication.

Then things took a turn for the worse. The author’s fragile world became overrun by demons, whom she believed were out to kill her. Less than a year later, the demons had become more than she could deal with and she sought treatment in hospital. It would take another 12 months before she could finally accept her illness and deny her demons. Happily, she is now able to live a peaceful life, and she continues to maintain her legal practice.

In contrast to the often terrifying flights of psychosis in the first chapters, Jacobs’s mother’s story is one of grief, guilt, and harrowing concern. Beginning with Kerry Jacobs’s first admission to hospital, Pam Jacob’s story is raw with emotion as she battles with her daughter’s reluctance to accept her illness, and a healthcare system that is not fulfilling its promises.

“I felt guilty most of the time because my heart sank every time she visited me,” Pam Jacobs writes, “and I knew that I would be on edge the whole time, watching her for obvious signs of psychosis.”

While Pam Jacobs tries on numerous occasions to help her daughter, Kerry Jacobs refuses to let her be involved in her care. The mother’s chapters fill in the gaps in her daughter’s memory from this time, recounting the trauma and failure of a range of medications. Finally, after 18 months of turmoil, Kerry Jacobs’s psychiatrist changes her medication and suddenly she began a symptom-free life.

Reading the book, I had to stop on several occasions to reflection my own experiences as both a sufferer of and caretaker for someone with bipolar disorder. I wish that I’d had this book during the time I was struggling to get my adolescent son’s symptoms stabilized. Learning about Jacobs’s most difficult periods of psychosis and her subsequent stable life and successful legal practice would certainly have given me strength. Readers with a connection to bipolar disorder will feel less isolated when they read Jacobs’s book.

From Psychic to Psychotic and Beyond: A true story about my bipolar disorder
CreateSpace Independent Publishing Platform, December, 2012
Paperback, 188 pages
$9.95

So many times we think we know where we’re headed; then we’re taking an unexpected turn.
~ Hopping Roller Coasters

Rachel Pappas’s memoir, Hopping Roller Coasters, details the unpredictable story of a mother and daughter who must cope with their mood disorders, until they can reach a place of mutual understanding that gives way to a stronger relationship with each other. Though I found the content to be emotionally painful at times, I think it’s an insightful read. Pappas provides us with an important takeaway message that revolves around genuine forgiveness and a path for healing.

Rachel’s story highlights her trials with bipolar disorder and how it affected her daughter, Marina. She transports the reader into their private moments, showcasing intimate arguments, where Rachel took out her frustrations on Marina in a raw and angry fashion. She didn’t mean the sentiments that came forth during the heat of an altercation, but biting words circulated between them. Rachel’s therapist ultimately put her on medication to regulate her mood swings.

We then read how Marina went through a period of hard knocks during early childhood and into adolescence; she had trouble focusing at school (she was diagnosed with auditory deficits), and she inherited her mother’s bipolar disorder as well. In desperate need of help, Marina endured a period of hospitalization and even moved away to live with her grandparents, hoping for a finer environment.

During Marina’s stay at her grandparents’, at 13 years old, she was hospitalized for getting hold of her grandfather’s painkillers. After a stretch of time, Rachel received a phone call from her mom, relaying the news that they couldn’t keep their granddaughter with them any longer. As difficult as it was to hear, she knew her daughter needed something more.

Marina also unfortunately struggled with cutting as a way to deal with her emotional turmoil. One of the more heartbreaking lines I read was when Marina explained why she did what she did. “It hurts on the inside, so I figured I might as well hurt on the outside,” she told her mother.

Fast forward a few years later: Marina was 16, and she and Rachel were at it again. Hurtful remarks and threats flooded their fights. “Where was my little girl? The one with the pixie cut who let me hold her hand crossing the street?” Rachel wrote. “My good-natured ‘pipster’ who accepted my excessive hugs and kisses into early puberty. I was losing her. No, I had lost her.”

What really struck a chord (even though I’m only in my 20s) was looking at this situation from the mother’s perspective. I could only imagine a parent’s sense of loss, among other things, when you’re watching your child transition away from childhood and into young adulthood. Now throw in that kind of strife, and it takes that particular awareness to a different level.

After another hospitalization at 18 years old, Marina went back on her medication and was finding her stride with a new job. She also began her first serious romantic relationship (which was definitely enjoyable to read about), and facets of her life were beginning to fall into place after a rocky decade.

In the final chapters, Rachel faced additional obstacles, but through it all, she found a new outlook regarding her relationship with Marina; she realized she didn’t want any friction in the connections that she valued.

By some twist of fate, Rachel’s personal challenges mended her history with her daughter and paved the road for forgiveness in both directions. They both knew that they unintentionally caused the other pain in the past, but they were able to move forward, become unstuck and salvage what really mattered. For that, I recommend this narrative.

Though the book could have used a good editor and been more intuitively organized, it’s still a fairly compelling read, and offers some pointed comparisons between the Spiritist approach and the modern mainstream U.S. approach — the latter of which views mental illness as a physical disease to be medicated away despite the sometimes crippling side effects of medication.

Bragdon begins by introducing us to Gerry, an “attractive young woman” who experienced what seemed to be a psychotic break during a time of extreme stress. About four years ago, Gerry began exploring alternative forms of healing, including consulting with Bragdon, a spiritually-oriented psychologist. Now, Gerry is doing well, engaged, and intending to enter graduate school. The author writes that Gerry’s recovery was facilitated by empathy, encouragement, caring health professionals and family members, and “teachers who helped educate her about lifestyle choices.”

This approach, Bragdon tells us, mirrors the Spiritist methodology that is currently in practice in Brazil, where more than 12,000 Spiritist community centers and 50 Spiritist psychiatric hospitals freely offer “a highly effective… program of integrative care, treating the needs of the public side-by-side with conventional medical practitioners.” It’s a community-oriented, relationally-focused, holistic and welcoming model that treats the patient as a human being who has just as much insight into her illness as any professional. But it also involves some practices that the average U.S. citizen might find unfamiliar.

“According to Spiritists,” writes Bragdon, “optimal wellbeing is ours when we are 1) doing the mission that we agreed to do before coming into this life and 2) treating ourselves and others with compassion consistently.” She goes on to explain that a Spiritist “considers that a pervasive and long-lasting mental imbalance that threatens life may come because a person is rebalancing themselves after a life experience that was not compassionate or may come from having lost his/her purpose in life.”

That part may not sound unusual, save for the part about making agreements before we were born. But the Spiritist approach offers multiple techniques that a non-religious, States-bound consumer might find “out there.” These include the laying-on of hands, inspired speech and prayer, blessed water, peer support for the patient and the family (called “fraternal assistance” in the book), interactions with mediums and psychics, and a post-hospital program of study and philosophical and spiritual conversation. It also welcomes family members and loved ones to be involved.

Although it’s unlikely that the U.S. healthcare model is going to follow the Spiritist one anytime soon, and although the author doesn’t provide objective proof of the success of the treatment, what I found fascinating about Bragdon’s book is how the Spiritist approach reflects some of the insights the mainstream psychological community has come to about mental health. The differences are obvious, but the underpinnings between these two very disparate models is surprising. Some descriptions of the Spiritist approach that may sound more familiar:

“The inspired speech directs the patients to focus on the value of compassion and love, helping them recollect loving relationships they may have had or may long for, assisting them toward greater self-acceptance, compassion, and tolerance,” one description goes.

“Perhaps Spiritism has been so successful in its treatments because it facilitates individuals clarifying their life purpose and aligning with that purpose,” Bragdon posits.

“The treatment aims at working with the patients’ motivation and with their state of readiness or eagerness to change.”

Another passage describes spirits that cause negative thoughts. Taken together, these concepts of forgiveness, self-acceptance, compassion, life purpose, negative thoughts, and motivation are all vital aspects of established psychotherapy modalities such as Cognitive Behavioral Therapy, Buddhist Psychology, Acceptance and Commitment Therapy, and Motivational Interviewing.

Bragdon’s book may be of limited value unless one is interested in different cultural approaches to psychological treatment. For those who are intrigued, however, it draws a compelling Venn diagram of the similarities between seemingly separate schools of thought. The author’s description of several U.S.-based holistic mental health clinics certainly gives the reader hope that there are people in the States working to change the dominant “medication-not-meditation” paradigm — even as we’re slow to accept alternative healing methods.

Resources for Extraordinary Healing: Schizophrenia, Bipolar and Other Serious Mental Illnesses
CreateSpace Independent Publishing Platform, February, 2012
Paperback, 264 pages
$24.95

Medication

With most psychiatric illnesses, medication is optional, and individuals can improve with other treatments, such as psychotherapy, said John Preston, Psy.D, a psychologist and co-author of Loving Someone with Bipolar Disorder and Taking Charge of Bipolar Disorder. However, “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.”

Patients typically need to take multiple medications. “On average, people with bipolar disorder take three medicines at the same time,” Preston said. A large study by the National Institute of Mental Health found that 89 percent of people with bipolar disorder who were doing well were taking several medications.

“Don’t be discouraged if it takes a while [to find the right medicine]. Almost everyone who’s successful has to go through the same process.” That’s because in order to find the best treatment for each individual, doctors prescribe various medications and combinations. The goal is to find the right combination with the fewest side effects.

Unfortunately, troublesome side effects are the rule, not the exception, Preston said. In fact, around 50 to 60 percent of patients stop taking their medication or don’t take it as prescribed. This is why having regular and honest communication with your prescribing physician is critical.

But many people feel uncomfortable. They don’t want to “complain,” or assume their physician will be upset with them, Preston said. “I find that clients often don’t think they’re allowed to disagree with their doctors, and often end up going off their meds rather than having candid discussions with their doctors,” said Sheri Van Dijk, MSW, a psychotherapist and author of five books, including The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.

Remember that you and your doctor are a team. “You have every right in the world to talk about every problem you run into,” Preston said.

The other reason people stop their medication is denial or wishful thinking, he said. It can take months after stopping medication for an episode to occur. This only validates the person’s belief that they don’t have the illness.

But while episodes may not be fast, they tend to be furious. Episodes typically get more and more severe, Preston said.

“Long-term studies that have followed people with bipolar disorder who have stopped taking their medication and have current episodes show progressive damage to parts of their brain.”

Lifestyle Management

According to both experts, cultivating healthy habits is paramount. Sleep deprivation and substance abuse exacerbate bipolar disorder and derail treatment, Preston said. Even patients who receive effective treatment don’t end up getting better if they’re abusing drugs and alcohol, he said.

If you’re struggling with substance abuse, seek professional help. Make sleep a priority. Try to get seven to eight hours of slumber per night, and wake up at the same time each morning. Consult your doctor if you’re traveling between time zones, which boosts the risk for manic episodes.

Social Support

“Often the success or failure of treatment has to do with how the family is involved,” Preston said. Family can either play a positive part in treatment or unintentionally undermine it. For instance, a family member who finds out their recently diagnosed loved one is taking medication might say, “You don’t need to take medication; you can handle this on your own,” Preston said. Again, not taking medication for bipolar disorder “can spell disaster.”

On the other hand, families can advocate for their loved ones. For instance, a parent might accompany their child to therapy when they’re in the throes of an episode and can’t articulate their concerns or symptoms.

Support groups, whether in person or online, also can be helpful, Van Dijk said. They remind individuals they’re not alone.

Psychotherapy

“The backbone of treatment is medication. But psychotherapy is enormously important,” Preston said. “While medications help to stabilize mood, they don’t change our thinking patterns, and the way we think affects the way we feel,” Van Dijk said. For instance, learning to change the negative stories swirling in your head may help prevent depressive episodes, she said.

Take the example of a client who was upset because her family pretended to forget her birthday, so they could give her a surprise party. “Instead of focusing on the surprise and the thought that her family had put into the surprise party, she was focused on how ‘cruel’ it was for them to pretend they had forgotten her birthday,” Van Dijk said. She helped this client “take a less negative and more neutral perspective on these kinds of situations.”

Van Dijk also teaches her clients mindfulness or “living in the present moment and practicing acceptance.” This helps clients not only accept their diagnosis but also become more self-aware. “We become more aware of our thoughts, our emotions, and our physical sensations because we’re in the present moment more often, and because we’re working on allowing ourselves to have these experiences, even if they’re painful.”

This self-awareness may prevent symptoms from escalating. By being more mindful, patients can spot an emotion and figure out what to do about it — “if anything” – before letting it careen into a full-blown episode.

According to Preston, “Numerous studies show that family-focused psychotherapy plus medication is really successful.” The goal of family-focused psychotherapy is to help the patient and family fully grasp the gravity of the illness and the importance of ongoing treatment, he said. It also teaches families how to provide support.

Interpersonal and social rhythm therapy also involves the family or significant other. The goal of this therapy, Preston said, is for “families and couples to learn to communicate more effectively and reduce really intense emotional experiences. It also incorporates strategies for lifestyle management.”

A big problem with psychotherapy is that clinicians who specialize in these treatments can be tough to find. Preston recommended checking out the Depression and Bipolar Disorder Support Alliance for facts on finding a professional along with other valuable information.

Accepting that you have bipolar disorder can be difficult. But not following your treatment will create a life filled with “one catastrophe after another,” Preston said. Instead, as both experts stressed, be honest with yourself. And make a strong commitment to taking your medication as prescribed and practicing healthy habits, without abusing drugs or alcohol.

Further Reading

Preston recommended these additional resources:

• The Bipolar Disorder Survival Guide
• Bipolar 101
• Bipolar Medications: A Concise Guide to Medication Treatments for Bipolar Disorders in Adults and Adolescents
• Consumer’s Guide to Psychiatric Drugs
• The website Bipolar Happens

Kakonge says that the book contains her “own babble through sixteen breakdowns over a five and a half year period.” The memoir is broken into small chapters, each offering a brief glimpse into the author’s life.

Through these diary-like musings, we witness the daily struggles of a young woman who experiences a variety of symptoms of mental illness. Kakonge discusses her numerous trips to psychiatric wards and the multitude of diagnoses bestowed upon her during these visits. In addition, she discusses the continuing struggle that she has had with whether or not to take psychotropic medication.

Memoirs may seem like they are a dime a dozen nowadays. What is worthwhile about this one is that the author does not allow her mental illness to prevent her from chasing her dream of becoming a journalist, even traveling from Canada to Africa in pursuit of a fulfilling career. All the while, the symptoms of mental illness continue to interfere. Yet Kakonge’s enduring will to succeed keeps the reader rooting for her success.

Kakonge also does an excellent job of drawing the reader into her reality during periods of psychosis. She does not sensationalize her situation; rather she describes her at times bizarre thoughts with a refreshing amount of frankness. For example, in the book’s opening she states:

“The security guard outside the door keeps looking at me strangely…Doesn’t he understand? This is a national emergency. I have to get out of this room because the women are coming to get me. Princess Diana, Oprah Winfrey, Princess Toro…are coming to get me to join their group.”

Kakonge does not attempt to psychoanalyze herself and figure out why she had such beliefs at that point in her life. Nor does she pass any type of judgment on herself. She simply lays her truth bare and allows the reader to come to his or her own conclusions.

In my own work as a counselor, I have facilitated writing groups for individuals with a variety of psychiatric diagnoses. Through this work I have seen the difficulties that can arise when one attempts to write about periods of mental distress. Oftentimes, writers are either hesitant to recall such memories, or unable to accurately remember the details of particularly stressful situations.

Knowing this makes Kakonge’s work even more impressive. I do not know whether she wrote this account strictly from memory or if she kept a journal during the time period she writes about. Either way, the detailed narrative of How to Talk to Crazy People offers an exceptional depiction of an individual’s struggle with mental illness.

The biggest fault I found in this work is its brevity: The book seems to just scratch the surface of Kakonge’s experience. It would be interesting to learn more about the author’s current thoughts as she recalls these tumultuous periods in her life, as well as to hear more about how she was able to overcome her mental health issues and find her voice as a writer.

Anybody who is looking to read an inspiring memoir about mental illness should check out How to Talk to Crazy People. This slim volume provides the reader with an honest portrayal of what it is like to live with psychiatric symptoms. Kakonge is refreshingly open. The reader comes away with not only a better understanding of mental illness, but also with a sense of encouragement from the author’s remarkable journey.

How to Talk to Crazy People
Life Rattle Press, 2012
Kindle edition, 88 pages
$20

Given my relationship with a woman experiencing the disorder, Jane Thompsonʼs Reboot: A Novel of Bipolar Disorder resonated quite strongly with me. Thompsonʼs book offers a fictional but true-to-life account, with her writing clearly based on her own struggle with the illness.

What struck me most is how Thompson reveals, in detail, the importance of what took me years to learn: that, due to the very nature of bipolar disorder, the person who is bipolar does not recognize this and may often forget or highly distort what happens in their manic state. In their euphoria they may imagine and remember, quite incorrectly, that everything was oh-so-wonderful, which is often quite far from the case. Particularly for an adult with bipolar disorder, recognizing the illness is a key step in the possibility of regaining stability and mental health. Without this recognition, an adult with bipolar disorder may quit taking medication, not prepare for the next manic episode, or put themselves and others at risk.

In the beginning, we find this lack of recognition in Marie, the protagonist suffering from the disorder and whose story parallels the authorʼs (and my girlfriendʼs). Marie misses appointments, remembers meetings cancelled when in fact, they had not been, and loses friends who seem standoffish to her. Before her treatment, she only dimly understands why her actions are irrational, rude, or possibly hypersexual. 

What makes Thompsonʼs book so fascinating and hopeful is the contrast between Mariaʼs lack of understanding before she realizes that she is bipolar and her later recognition of what was more likely going on when she finds a medication that works for her.

“Reboot” details another important facet of bipolar disorder. While it is defined as a psychiatric mood disorder with disruptive mood swings, characterized by one or more episodes of abnormally high energy levels, accompanied by racing thoughts and euphoria, with or without depressive episodes, no one truly knows what causes it and what can stop it. Treatment and medication are thus experimental. In the book, Marie takes several different medications with no apparent effect. After reporting this to her physicians, she is told that the medications will eventually work, or that she doesnʼt realize that they are indeed working.

Thompsonʼs novel also correctly illustrates the dangerous side-effects of these medications. Marie is advised to take Haloperidol, which could lead to tardive dyskinesia, i.e., involuntary repetitive body movements, and is told incorrectly that she is not old enough to develop the symptoms. My own reading of the dangers of such medications had me worry when my girlfriend Elle, at about the same age, temporarily developed a habitual puckering and pursing of her lips after taking the many medications, including Haloperidol, that she was prescribed. For both Marie, in the novel, and Elle, in my own life, therapy is trial and error. One hopes to find a treatment or medication that works.

Without giving away the bookʼs lovely ending: Marie finally finds a drug that works for her. As her moods stabilize, so does her life. She gets a significant raise at her job of several years, makes friends, and begins to enjoy going out. She starts to feel appreciated for who she is, and is happy.

I wiped tears from my eyes and broke out laughing several times as I read “Reboot.” For those of us who are close to someone suffering from bipolar disorder, this book means a lot.

Reboot: A Novel of Bipolar Disorder
CreateSpace Independent Publishing Platform, June, 2012
Paperback, 264 pages
$15 

With this approach, Jones, a long-time law professor at the University of Louisville, models himself after Elyn Saks and Kay Redfield Jamison, other successful academics who “came out” as having serious mental illness after concealing their conditions for many years. Both Saks and Jamison wrote graceful and poignant memoirs detailing how they managed to lead successful and fulfilling personal and professional lives in the face of chronic and often disabling conditions – schizophrenia in Saks’ case and bipolar disorder in Jamison’s.

A Hidden Madness is less a tale of dramatic dysfunction, then, and more one about how Jones came to accept the reality of that dysfunction and took all necessary steps to bring himself back from the brink of his crushing depressions and, to a lesser extent, florid manias. Jones is, as he notes, a rare example of a patient with bipolar disorder who has been almost completely compliant with the advice of his doctors and therapists. He repeatedly sought out top-notch experts to provide him with both medication and therapy, and quit his medication against medical advice just once in three decades of treatment.

Jones considers his compliance with his clinicians’ advice as crucial in his ability to succeed personally and professionally, to weather breakdowns that might otherwise have left him jobless, homeless, friendless and penniless and, often, to allow him to come back stronger than before.

But his book is more than a simple lecture on the virtues of doing what the professionals say. It is also an account of how many, small, everyday life choices can make a huge difference in the outcome of serious mental illness. Much has been made of the therapeutic effects of pets; Jones’s utter devotion to the several dachshunds he has owned since childhood, including one whom, he says, he “almost worship[ed]” is touching and a testament to the strength many people derive from having animal companions who love and stick by them unconditionally.

Similarly, what may strike some readers as tangents about Jones’s eclectic hobbies — an almost obsessive love for classical music and fervent enthusiasm for target shooting, medieval and civil war reenactments, war games, and other pursuits – show the importance of having passions outside of work and family commitments, as well as having friends who share these interests.

In Jones’s case, his ability to sustain enthusiasm and commitment to these activities, as well as to his pharmaceutical and therapeutic treatment, is especially notable. He details again and again how his “fragile ego” is “inextricably linked” to his academic and career success; setbacks in these realms plunge him into ghastly relapses on repeated occasions. Given this outlook, it is easy to see how he could have focused on his career at the expense of almost everything else. Yet even as he suffers through powerful suicidal thoughts and urges, he is somehow, remarkably, able to distance himself from the all-consuming misery of the present and take steps that deep down, he knows will help him recover.

Yet, A Hidden Madness mostly manages to steer clear of being self-serving or grandiose. Jones is painfully frank about his shortcomings and mistakes, and poignantly bears his doubts and insecurities. Occasionally, he seems a little too eager to justify himself to the reader, to explain career and personal setbacks as the misunderstood outgrowths of his disorder (digressions into academic politics, for example, will likely strain most readers’ patience).

Even these sometimes-labored explanations, however, bear witness to an important underpinning of the book itself and to Jones’s motivation for writing it. Ultimately, it is an attempt to explain and explore the stigma that still keeps so many with emotional and behavioral problems — especially those with particularly stigmatized conditions such as bipolar disorder, schizophrenia, severe depression, and personality disorders – from revealing to employers, colleagues, and even friends and family the reasons for their ongoing struggles.

It is telling that a tenured professor, perhaps one of the most secure professions that exists, was still too terrified of sanctions and judgment to disclose his condition to any of his colleagues for the better part of two decades. Afraid to ask for help, Jones describes himself as “out in the dark, a marginal figure in the world.” Poignantly, he writes that, “Effectively the only ones to whom I could open my heart were the doctors and therapists I paid to listen to me.”

Many readers who cope with chronic mental illness, or those with loved ones who do, are a likely to find the overall arc of A Hidden Madness to be both compelling and inspirational. That said, the book has notable weaknesses, especially when compared to the best memoirs of mental illness.

Jones’s prose can be clunky, and, more frustratingly, he tends toward general descriptions of his emotions and behavior, often failing to bring alive what it actually feels like to be depressed, suicidal, manic, or anxiety-ridden. Throughout the book, I found myself wishing that Jones could more powerfully and evocatively describe his depressions and manias, as well as his recurrent self-doubt and self-loathing, to animate these moods and states of mind for readers who have never experienced such things. When he did include details – hearing complete operas and symphonies in his head while manic, for example, or going off on wild tangents about soap opera trivia while teaching law school classes – it significantly enlivened the narrative.

I had initially been attracted to the book because I’d heard it discussed the social isolation and brutal bullying that Jones experienced as a child and teenager and hoped it might elucidate how this early trauma contributed to his later illness, which wasn’t treated until his mid-20s. Jones notes repeatedly that the experiences plunged him into early depressions and briefly mentions that research has established links between bullying and bipolar disorder in particular. But unfortunately, he neither recreates his experience in enough vivid detail to give readers a sense of what he actually suffered nor goes into a broader discussion of the research on the topic. In general, the book would have significantly benefited if Jones had placed his story in a broader context more often, explaining how his own experience was typical or atypical of others with severe mental illness.

Still, A Hidden Madness remains a powerful account of the travails of bipolar disorder and its effects on family, social life and career. And most importantly, it demonstrates that with the right supports and the right outlook, resilience in the face of repeated emotional crises really is possible.

A Hidden Madness
By James T.R. Jones
Paperback
322 pages

Challenge: Uncontrollability

“Bipolar disorder can feel uncontrollable,” according to Sheri L. Johnson, Ph.D., professor of psychology at the University of California-Berkeley and director of the Cal Mania (CALM) Program. Symptoms, such as mood changes, can seem to appear suddenly and without provocation. And they can diminish daily functioning and ruin relationships, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder.

Strategies: While bipolar disorder can seem unpredictable, there are often patterns and triggers you can watch out for. And even if you can’t prevent symptoms, you can minimize and manage them.

One way to monitor changes is to keep a mood chart, Van Dijk said. Depending on which chart you use, you can record everything from your mood to the number of hours you slept, your anxiety level, medication compliance and menstrual cycle, she said. (This is a good chart, she said.) For instance, you can anticipate a potential depressive episode if you see that your mood has been progressively sinking in the last few days, Van Dijk said.

Practicing healthy habits is an effective way to lessen the hold emotions have on you. Make it a priority to get enough sleep, going to bed at the same time and waking up at the same time, Van Dijk said. Create a calm bedtime routine, avoid substances such as alcohol – which disrupts sleep – and don’t exercise in the evenings, said Johnson, also co-author of Bipolar Disorder: A Guide for the Newly Diagnosed.

Sleep deprivation can trigger mania, and “it makes you more susceptible to being controlled by your emotions, such as irritability,” Van Dijk said. On the other hand, sleeping too much can cause lethargy and also reduce your ability to manage emotions, she said.

Exercise helps to reduce depressive symptoms. Eliminating caffeine can reduce irritability and anxiety and improve sleep, Van Dijk said. She suggested cutting out caffeine for two weeks and paying attention to any changes. Some people also find that certain foods exacerbate their mood swings. You can check by cutting out specific foods from your diet, and watching the results, she said.

You also can use a variety of strategies to stave off the negative consequences from your symptoms. For instance, if impulsive spending is a problem, gain control by having a low limit on your credit cards, Johnson said. When you’re experiencing early signs of mania, have someone else hold onto your checks and cards, Johnson said. If you do overspend, return your purchases, she said. You can even ask a friend to go with you, she added.

Challenge: Medication

“There is no ‘one size fits all’ medication that helps everyone with bipolar disorder,” Johnson said. Lithium is typically the first line of treatment. But for some people the side effects are especially troublesome, she said. Finding the right medication (or combination of medications) can seem like a daunting process.

Strategies: Learn as much as you can about mood-stabilizing medications, Johnson said, including their potential side effects. “Find a doctor who will work with you to make adjustments based on your experiences with the different medications,” she said. Expect that it might take several tries to figure out the best medications for you.

Many of the side effects dissipate after the first two weeks, Johnson said. Changing the dose schedule helps to minimize side effects. For instance, if you feel groggy, your doctor might suggest taking your medication in the evening, she said.

Support groups are another valuable tool, Johnson said. (She suggested looking at the Depression and Bipolar Support Alliance website for a group.) For instance, individuals in these groups are usually familiar with compassionate doctors in the area, she said.

Challenge: Relationships

Bipolar disorder is hard on relationships. The very symptoms – swinging moods, risky behaviors – often leave loved ones feeling confused, exhausted and like they’re walking on eggshells, Van Dijk said.

She also sees loved ones have difficulty distinguishing between the illness and the person. They might invalidate the person’s feelings and either blame everything on the illness or believe the person is making conscious choices when it is the illness.

Strategies: Bipolar disorder is difficult to understand, Van Dijk said. “Different affective episodes, [such as] depression versus hypomania, result in different symptoms, and one episode of depression or hypomania can be different from the next within the same person,” she said.

So it’s incredibly important for loved ones to get educated about the illness and how it functions. Individual therapy, family therapy and support groups can help. Refer loved ones to self-help resources and biographies or memoirs of people with bipolar disorder, Johnson said.

Getting a handle on your emotions also improves relationships, she said. Working on assertiveness is key, too, she said. Individuals with bipolar disorder tend to have a tough time being assertive. Therapy is a good place to learn assertiveness skills. But if you’d like to practice on your own, Van Dijk suggested using “I statements”: “ I feel _____ when you ______.” She gave the following example: “I feel scared and hurt when you threaten to leave me.”

Challenge: Anxiety

According to Johnson, about two-thirds of people with bipolar disorder also have a diagnosable anxiety disorder.

Strategies: Johnson stressed the importance of using relaxation techniques and not using avoidance behaviors. As Van Dijk explained, “the more you avoid things because of your anxiety, the more your anxiety will actually increase, because you never allow your brain to learn that there’s nothing to be anxious about.”

Psychotherapy is tremendously helpful for managing bipolar disorder and the above challenges. If you’ve been prescribed medication, never stop taking it abruptly – this boosts the risk for relapse – and communicate regularly with your doctor.

In her book, Campion discloses the events leading up to every parent’s worst nightmare: the death of her daughter, Luce. Campion describes the heartbreak of witnessing her daughter’s descent into depression and drug use, and the helplessness and guilt she felt as both a psychiatrist and a mother. Sshe and her family were unable to prevent Luce from the early death which seemed inevitable from a young age. In her painfully honest account, Campion also explores her history and that of her family in trying to figure out what may have contributed to Luce’s death.

“Luce looked at me straight on. ‘It really sucks. I get the manic-depressive gene from you, and the weird drug reactions from Dad.’”

Campion talks of her own battle with depression and reveals her youthful suicide attempts. She also talks of her husband’s alcoholism, and the trials her family has endured because of addiction and the trauma of losing Luce. Campion confesses that she didn’t fully realize the scale of the problem until it hit her own family:

I didn’t know then that major depression strikes about one in ten women every year. According to U.S. public health data, among adults experiencing a major depressive episode, fifty-six percent thought that it would be better if they were dead, forty percent considered suicide, fifteen percent made a plan, and ten percent an attempt. Suicide is the eleventh leading cause of death among adults and accounts for well over thirty thousand deaths per year. I would learn only later that what we now call bipolar and unipolar major depressive disorders had surfaced with regularity in my family for several generations.

Much of the book comes across as Campion’s attempt to make sense of her loss and move on from it. Guilt is a recurring theme throughout the book. As Campion recalls trying to help her daughter, she comments that “Every decision I’d made during her illness could be used to flagellate myself.” Any parent will be able to identify with the agony Campion faces as she repeatedly asks herself what she could have done differently.

Looking back on that time, the hardest thing to do is recapture how dense my ‘not-knowing’ was. From today’s vantage point, it is hard – no, impossible – to ignore what would be revealed a few months later in the full-blown manifestation of Luce’s manic-depressive illness. I want to flog myself for not considering what seems so plain in hindsight: her excessive confidence, single-minded purpose, intense energy, and powers of persuasion could indicate a manic episode. Why didn’t they raise my suspicions? Some psychiatrist! Or was I, her mother, just too tempted to welcome her new bright optimism, focus, and appetite for life after years of confusing doubt… The guilt of failing my own child swells up in me like a flooding river, dirty and cold, hauling dangerous debris.

The book serves not only as an incredibly revealing, painfully honest account of a parent’s loss but as a reminder of the importance of family. It is clear from the start how important Campion’s family is to her, and how much the family relies on each other throughout their struggles:

Every single one of us had been traumatized… I thought the best way to heal was to give each other warmth, to huddle close, in order to withstand the real world’s harshness.

Indeed, Campion examines in great depth the effect the tragedy had on each family member. It is this systemic analysis of her story, taking into account the role of each individual family member, which doubtless evolves out of Campion’s professional experience as a psychiatrist. Campion wonders how and why the family were able to stay so strong and reliant on each other during their experiences, and ponders the importance of attachment:

Equally mysterious, and possibly closer to the truth: I have a strong affiliative need that I think is hardwired in most humans and other mammals, expressed in loyalty to their tribe or pride. As if the family was the basic organism whose survival may be more essential than any individual’s, the whole being greater than the sum of the parts.

While this powerful memoir will appeal to anyone who has lost a close family member, it also serves as an important reminder to all mental health professionals that they are not immune from any of the conditions which might plague their clients.

Did I think I was any better than those patients and their families, that I deserved to be spared? By virtue of what? I knew better, except that, deep down, I must have hoped that all the energy I had spent battling addiction and mental illness for years would count in my favor. As if I could bargain with fate, buy protection for my contributions. But destiny is crueler than any mafia goon.

This will be familiar territory for any professionals who might be wounded healers themselves, particularly those who have dealt with their own loss, trauma, addiction, or depression while still attempting to see clients. Campion talks of her own battle to carry on working, until she realizes that it would be unethical, and refers her clients elsewhere:

Another patient told me, on the tenth anniversary of her own suicide attempt, ‘I have been able to resist all those years because you’ve been on my side. But since your daughter died, you’re not as strong and I think I’ll kill myself.’ Her words stabbed me, but she was right and I convinced her to work with another doctor.

Although the book is at times so searingly honest that some readers may find it hard to take, this is ultimately a story of redemption. Writing this book undoubtedly was cathartic for Campion, and a therapeutic means for her to reach some kind of closure over these awful experiences. In the end, it is the simple capacity for happiness and hope which seem to have saved Campion from the same demise as her daughter:

I have been blessed with an innate ability for joy that bubbles easily in me except during the severe depressions I’ve had four times in my life. Even after months of low moods, I recovered completely and regained a buoyancy that reminds me of my grandmother, who soothed us with bedtime stories during the war… I have worked hard to deal with traumas and temper my neurotic traits, but that inborn undeserved talent for enjoying life is a gift I can only give thanks for and celebrate… Luce had no such luck.

Hope triumphs, even through the unknowable. And, for that, we must all be grateful.

Through the Unknowable: Family Life with Depression, Alcohol and Love
By Elsa Campion, MD
Vantage Press:  March 16, 2012
Paperback, 162 pages
$13.95

That’s because postpartum psychosis (PPP) is a “psychiatric emergency,” said Margaret Spinelli, M.D., associate professor of psychiatry at Columbia University Medical Center. Think of it as a heart attack, Twomey said. “You might survive it without immediate aid, but why risk it?”

PPP is a temporary but serious illness characterized by delusional thinking. Twomey, a survivor of PPP, described it as “a different reality superimposed onto this reality.” For instance, it’s like watching a TV show and believing that it’s perfectly normal for the actors to be speaking to you, she said.

PPP has a rapid onset, usually starting in the first days or weeks after the baby’s birth, said Katherine Stone, an advocate for women who suffer pregnancy- or childbirth-related mental illnesses and founder and editor of the award-winning blog Postpartum Progress.

This illness requires immediate medical attention because there is a risk of suicide or infanticide, Stone said. In other words, “postpartum psychosis has the potential to lead a mother to take actions that she would never otherwise take that could harm herself or others,” she said.

Still, it’s common for people to dismiss this risk. We know that our loved ones are good people who’d never hurt their kids (as are we), Twomey said. However, this has nothing to do with a woman’s character or ability to be a good mom, Stone said. (It’s also not her fault!) Again, PPP is an illness — and one with unpredictable actions, Dr. Spinelli said.

Fortunately, PPP is fully treatable. Below, experts discuss the warning signs, risk factors and how families and friends can help.

Warning Signs of Postpartum Psychosis

“Since women with postpartum psychosis often experience a lack of insight, it’s usually the people around her who will be the ones to recognize something is wrong,” Stone said. In fact, Twomey called family members “the first line of defense.”

That’s why it’s key for families to step in and call the doctor immediately or go to the emergency room. You might be thinking, “But what if I’m wrong?” What if she isn’t struggling with PPP? As Stone said, “I’d rather have it turn out that you were wrong, than have a person ignore the symptoms and have that lead to a tragedy.”

These are the most common signs of PPP.

• Hallucinations: seeing or hearing things that aren’t there
• Delusions: bizarre beliefs that only make sense to the individual. Delusions often have religious undertones. For instance, she might believe “…that her child is a savior or has been sent to save the world, or is possessed or going to come to some harm from nefarious forces if she doesn’t take action,” Stone said.
• Confusion
• Paranoia
• Mania (high energy)
• Depressed mood or irritability
• Inability to sleep

(In some cases, a woman might be rational enough to seek help. Twomey wanted women to know that “no matter what you experience, [PPP] is recognizable, diagnosable and treatable.”)

“PPP can wax and wane,” Twomey said. So even if a postpartum woman seems reasonable at times, don’t let that dissuade you from getting help. It’s a myth that women with PPP are either completely delusional or totally normal. As Twomey said, “a woman can seem perfectly normal one moment and psychotic the next.”²

Risk Factors of Postpartum Psychosis

Women with bipolar disorder or schizophrenia (or who have a family history of these illnesses) are most at risk, Stone said. Some women might not even know that they have either disorder. For instance, some moms might’ve never received a diagnosis of bipolar disorder, Stone said. In fact, according to Spinelli, PPP “usually signals a first episode of bipolar disorder.”

If you fit these risk factors, consider writing a letter to yourself explaining that you might have PPP, listing some of the symptoms and including the individuals you trust, Twomey said. If you do experience PPP, you’ll have given yourself important and sound information, she said.

Not having these risk factors doesn’t put you in the clear. Twomey emphasized that every expectant mom is potentially vulnerable.

How Family & Friends Can Help

• “Be informed before it happens,” Twomey said. This way you “can be an advocate, be aware of the warning signs, appreciate the dangers and treat her with compassion, love and understanding,” she said.
• Don’t ignore the signs. “I think family members sometimes want to explain away the symptoms of postpartum psychosis rather than admit a new mom has it and likely needs to be hospitalized,” Stone said. You might worry that she’ll be “locked up forever,” she said. But getting your loved one help is the best thing you can do for them — and their baby. Women with PPP are often hospitalized so they can get proper treatment. (This usually consists of close monitoring and taking antipsychotic medication.) But after they’re stabilized, women can return home. “Please don’t ignore the symptoms because of fear or lack of understanding!” Stone said.
• Don’t confuse your loved one with their illness. Twomey often hears husbands say that this isn’t the woman they married. Women with PPP can act completely out of character, even becoming verbally abusive, Twomey said. This might lead some families to alienate their loved one or view her as the enemy, she said. But it’s vital to understand that this isn’t your loved one, she said. PPP is causing this kind of odd behavior, Stone said. “…It would be unfair to blame her or stigmatize her for that behavior,” she said.
• Support your loved one. Give her your full support both while she’s in the hospital and after she comes home, Stone said. This includes helping her care for the baby and making sure she gets enough sleep, Spinelli said. Also, make sure your loved one is getting the best treatment, and go with her to doctor’s appointments, Twomey added. Stone recommended reading the valuable guides from the UK organization Action Postpartum Psychosis.

PPP is a serious illness that requires urgent treatment. If your loved one is experiencing any of the warning signs, don’t hesitate to get her help — and always be on her side, Twomey said.

Further Reading

Check out Postpartum Support International, a non-profit organization that’s filled with valuable information and resources. Also, Twomey wrote a helpful post on the three important bricks of PPP.

1. Statistic from Postpartum Support International
2. Check out Stone’s site, Postpartum Progress, for more on symptoms “in plain mama English.”

Cyclothymia affects up to 1 percent of the population. However, at a hospital’s psychiatric department, it’s anywhere from 3 to 5 percent, according to Dr. Stephen B. Stokl, MD, Chief of Psychiatry at Southlake Regional Health Centre in Ontario.

Cyclothymia is marked by bouts of low-grade depression and hypomania, which includes elevated or irritable mood, decreased need for sleep and racing thoughts for at least four days. Adults are diagnosed after symptoms persist for two years. (Kids and teens are diagnosed after one year.) “Cyclothymia has an insidious onset that starts in late adolescence or early adulthood, and has a chronic nature,” Stokl said. It’s milder than bipolar I and bipolar II.

Most people never get treatment, according to John Preston, PsyD, professor at Alliant International University and author of three books on bipolar disorder, including Taking Charge of Bipolar Disorder. That’s because the depressions typically aren’t incapacitating, and people do feel OK for periods of time, he said. (But these periods don’t last longer than two months, which DSM-IV stipulates for the diagnosis.)

In other words, because symptoms tend to be less debilitating, people just don’t realize they have an illness, said Sheri Van Dijk, MSW, a psychotherapist and author of The DBT Skills Workbook for Bipolar Disorder. It’s usually loved ones who notice a problem, finding it hard to live with someone who has unstable moods, Preston said.

In fact, the toll on relationships can be dramatic. “Cyclothymia usually comes with a high morbidity in terms of breakdown in relationships both personal and at work,” Stokl said.

Also, if untreated, cyclothymia can get worse. “At least half of the people with cyclothymia, over a period of time, will start developing increasingly severe mood episodes,” and will be diagnosed with bipolar disorder, Preston said.

Diagnosing Cyclothymia

Diagnosing cyclothymia can be tricky. It may be misdiagnosed as bipolar NOS, bipolar II or borderline personality disorder, Van Dijk said. But individuals with bipolar II tend to struggle with more severe depression.

As Preston explained, there also are important differences between cyclothymia and borderline personality disorder. A person with borderline personality disorder may appear to be experiencing a hypomanic episode by acting upbeat and animated. But their elevated mood doesn’t last long and it always happens after becoming infatuated with someone new, he said. (Once the infatuation fades, they’re back to feeling dejected.)

The hallmark sign of hypomania is a decreased need for sleep, Preston said. People with hypomania only sleep for four or five hours. But they feel no fatigue, while those with borderline personality disorder become exhausted, he said.

Also, “People with borderline personality disorder are exquisitely sensitive to feeling rejected and abandoned,” he added.

The best way to diagnose cyclothymia – and bipolar disorders in general – is to get a comprehensive history of the person’s mood, which requires talking to both the person and a loved one who knows them very well, Preston said. Loved ones are usually better able to spot the mood changes, he said.

As I cried, I wanted to believe it was the alcohol that induced Mom’s words.  I had to believe it was the alcohol.  I don’t want them.  The words rang in my ears.  That’s the night my heart first broke.

White Elephants is the story of Chynna Laird’s childhood with an alcoholic, bipolar mother.  Not for the faint of heart, this memoir is a gripping tale that Laird colorfully paints for those unfamiliar with what it is like to grow up in this situation.

This review’s opening paragraph comes from a story in the first chapter. Laird overhears a phone call between her grandmother and her mother.  Her mom is drunk and on one of her many “vacations” and Laird’s grandparents are taking care of Laird and her brother, Cam.  Five-year-old Tami (the name Laird went by for most of her life) hears her mother say on the phone, “I don’t want them.”  This scene sets the stage for the drama that plays through the rest of the book.

No one seemed to understand the manic behavior and profound depression of Tami’s mother, Janet. Janet’s siblings and parents were constantly at their wit’s end. Laird describes several points when her mother was clearly actively suicidal.

Living in a chaotic home filled with binge drinking, verbal and physical abuse will leave its mark on a child.  Tami was molested and raped in her own home.  She and her brother started drinking at a young age and were both involved in drugs at various points.  They both struggled with anger.  Cam raged on the exterior, punching walls and sometimes turning on their mother, whereas Tami unleashed her anger on herself.  She was known among other high school students for crying when she was drunk. By the age of 15, she had begun cutting and even attempted suicide one night.  As she grew older, Tami struggled with her self-esteem and developed bulimia.

In hindsight, Laird is able to recognize the “angels” who played a role in her life.  She and Cam were close to their grandparents, who practically raised them. They were the only real parents that Tami had ever known and their influence was prevalent through most of her life. 

Her stepfather, Pat, rescued her many times from herself and from her mother.  At 15, Tami was drunk at a party and had to call Pat to pick her up.  When they got home, he hugged her and told her he was not going to ask what happened.  “I just wanted you to know I’m glad you’re both home safe…You’re better than this, Tam.  You’re better than she is.” 

However, when Tami finally realized that she needed help, she turned to her godmother, “Auntie Lois.”  Tami moved in with Lois and her family and began a daily ritual of having tea with her aunt.  Over tea, Lois would patiently listen while Tami spoke about the trauma, the alcohol, and all of the other dark secrets that she had been carrying for so long.  This was the turning point for Tami:

In that moment, as I felt Auntie Lois hug me – a person who really believed me, a person so close to God she could be considered an angel – the flood gates opened and I cried.  I cried for the little girl I never was.  I cried for all the times I hurt but couldn’t react.  I cried for not having a mother who loved me the way she wanted to.

White Elephants touched me much more than I expected.  Laird says that she wrote the book in hopes that it would help someone who has been in a similar situation.  Because she could not help her mom, she hopes that someone can find some help in her story.  Although I have not been through the trials that she has, her strength and determination to not allow her mother’s abuse to determine her future is admirable and inspiring.  The moment I began reading her book I could not put it down.  Moreover, after finishing it 24 hours after I started it, I was ready to read it again.  There are not enough adjectives to adequately describe White Elephants: inspiring, tragic, heroic, admirable, honest, and deeply moving.  There were points when I found myself crying along with Tami and others when I was cheering for her on the sidelines during her recovery.

I think that Laird accomplished her goal through her story.  Not everyone will be able to relate to the events, but I believe most people will be able to relate to the struggle of pulling yourself out of depression and finding your own feet to stand on.  In this way, Laird has most assuredly accomplished her goal for this beautiful book.

White Elephants – A Memoir
By Chynna T. Laird
Eagle Wings Press: February 1, 2011
Paperback, 280 pages
$14

Family and friends might be unsure if recovery is possible. They question how they can help. Mental illness creates a feeling of helplessness for everyone involved. My and my family’s experience with chronic mental illness has allowed me to understand how important it is to have a support group. It can define the journey taken to recover from mental illness.

My diagnosis is rare. I was diagnosed with bipolar II disorder when I was 12. While my siblings were attending school and playing soccer on weekends, I was confined to a children’s psychiatric hospital. I remember wondering what was wrong with me. I remember my parents, wide-eyed, watching as my moods shifted by the hour, even the minute. We were all terrified. Mental illness is frightening at its core.

Unsure what to do, my parents brought me to doctors, psychiatrists, therapists and even nutritionists. The various doctors told them I had Attention Deficit Disorder; the psychiatrists told my parents they were parenting me badly. They were certain that explained my erratic behavior.

The therapist asked me to draw pictures that they thought would explain my moods. I refused to use any crayon that was not black, threw the toys that were carefully placed around the brightly lit room, and tore up the paper. I was unable to control myself. She dismissed me as being ‘overemotional’ and ‘narcissistic’ at the ripe age of 11. The nutritionist told me I was allergic to dairy products. My family, in a show of support, stopped eating anything containing dairy.

Fourteen years ago, professionals simply could not believe a child could have a serious mental illness−despite our family tree being defined by mental illness and suicide.

The years before my diagnosis were painful and affected our family dynamic immensely. My two siblings watched their older sister fall apart; they viewed their parents trying to catch me as I fell into blackness. My illness was quickly making my family ill.

It is impossible to capture my experience with mental illness in a few words, but I can tell you that without the support of my family, friends and a support team, I would not be writing these words. Twenty-six years old now, I feel I have some experience under my belt (so to speak) and would like to share different ways in which people can support a loved one struggling with mental illness.

Often, a newly diagnosed person is confused and angry. They may believe they do not need help. They might push away family and friends. As a person living with a chronic mental illness, I can tell you that isolation often results from fear. Mental illness carries stigma and it is frightening.

For example: I fall into a severe and crippling depression each winter. Each time it occurs I am, somehow, surprised. I quickly forget that my life is usually full of color and that waking up each morning often makes me smile. When I become ill I am certain I will never be well again.

If a family member or friend is unstable, the most important thing you can do is remind them that they will become well again. Without my family and friends to help me through each winter, to assure me that my life will become mine again, once spring arrives, I would certainly struggle more.

It is important to have a plan of action. Effective communication will be crucial if the person with mental illness shows signs of a relapse. A plan of action for such an event creates a feeling of security both for the person struggling and for those who love them.

An example: My family and I sat down with my psychiatrist−once it was clear my episodes were seasonal−and made a plan, in writing, that stated the steps that would be taken if I became ill. It was a difficult thing to do at the time. Seeing my diagnosis on paper made it real. But that paper provides a feeling of security for all of us.

The plan can include medication alterations, community outreach, and simple things like charting your mood and recognizing patterns. I believe this can be one of the most useful tools when working to help someone recover from a mental illness. It certainly is not a document that is placed on my fridge—it’s hidden away somewhere—but it has been instrumental in my recovery.

The health of those who support the mentally ill person often gets ignored. When I first became ill, my entire family suffered. My parents, while working full-time and taking care of my two siblings, spent years focused on my illness and recovery. In the process, they became unwell themselves. My mother slipped into a depression and my father worked to keep our family functioning. It was not easy.

Often, when a person must spend so much time focusing on someone they love, they forget to take care of themselves. It is impossible to help someone else if you become sick yourself. Ask yourself: “Do I need to step back?” Sometimes you do. My family has learned both to support me and support each other. It is in this way that we have been able to embrace recovery together.

It is a very easy book to read and has many helpful tips to follow.  It contains seven chapters, in addition to the introduction, which starts with a neat description of the symptoms from the point of view of the person experiencing the disorder.  This makes it very easy to understand and makes the readers feel comfortable.

Chapter One deals with the basics and explains depression and mania, using easy-to-read, informative case vignettes. Perhaps the weakness was the overly-inclusive definition of moods which, like all vague, all-encompassing definitions, end up defining very little. However, this chapter also includes a checklist for the reader to use to help them recognize the symptoms of mania and depression.

Chapter Two focuses on how to get help and what young people can expect from professionals. I liked the fact that the authors offered examples of useful questions to ask of various professionals, as well as the type of questions young people likely will be asked by those same professionals. There also was a helpful description of medications and their side effects.

Chapter Three is crucial. The authors dedicated a whole chapter to the issue of accepting the illness. This has a decisive initial role in commitment to therapy. They illustrated this with Ashley’s moving story and her fears of revealing her diagnosis to the wider world, and her all-too-well-known pattern of discontinuing medication. It helps the reader to understand bipolar’s effects on their lives, and how to live with the diagnosis.

Chapter Four is about tools. “You don’t have to be a passive passenger being swept down the bipolar river” is one of the evocative sentences the authors used to introduce the key elements of successful recovery: creating a structured life; managing stress; getting good sleep; and learning to self-monitor.

Chapter Five addresses whether to tell others about the illness. It stipulates that total secrecy is probably not good at all, while exercising some discretion about confidants also is a good measure. The issue of a “helping team” is emphasized. It consists of a close circle of family, friends and trustworthy coworkers.

Chapter Six demonstrates that the book has been written for young people. “Managing Your Independence” focuses on academic overcommitment in college, dealing with ample opportunities for experimenting with drugs, alcohol and excessive partying, and the issues of psychiatric and psychological continuity.

Chapter Seven, “Looking Forward,” addresses the painful reality that sometimes long-term academic and professional goals might not be achieved. The reality of bipolar disorder sometimes forces young people to rethink important life plans. Finding the fine line between being too fatalistic and overly optimistic appears to be a challenge. Focusing on the individual’s strengths rather than weaknesses, the authors propose, will help in finding the optimal middle ground.  And even if things don’t go well, ‘picking yourself up’ appears to be a skill required to enjoy quality of life if you have bipolar disorder.

Overall, this is a good book and would be helpful for young adults diagnosed with bipolar disorder.  The vignettes are among the highlights. They are clear, relevant, and at times very moving. This will maximize the possibility of getting through to young people; frequently they relate much more effectively when the emphasis is on experiences.

Fortunately, academic accuracy has not been sacrificed in the name of accessibility. Important findings in the expert literature also are covered.

Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder
By Russ Federman, PhD and J. Anderson Thomson, MD
New Harbinger: February 2, 2010
Paperback, 176 pages
$16.95

I found the book to be both hilarious and sad. There were points when the author’s frustrations were becoming mine. This book is a no-holds barred, educational read that keeps the reader unable to put it down. I tip my hat to Stacy Pershall for sharing such a personal tale with us. It has changed my understanding of these disorders forever.

It seems to me the author was trying to share her very personal journey through early adulthood with BPD, BD, and various other problems. This she accomplishes in both an effective and entertaining manner. She told us her story from top to bottom, leaving nothing out. She also speaks very highly of Dialectical Behavior Therapy, though I’m not sure if she emphasized this as much as she had intended.

Her small-town childhood, her constant questioning of her identity are things that many people can relate to. Not knowing where one belongs, or who one is, are universal questions. Some people have a much easier time answering these questions than others. This is a concept I can personally relate to quite well.

I love Pershall’s honesty. On the medication front alone she offers anecdotes about her use of speed and alcohol; the side effects of prescription meds; the lack of correcting the underlying problem she experienced with pharmeceuticals; and her list of the plethora of meds she was prescribed.

Pershall’s describing Dr. Phillip J. Thornton as her savior of sorts is an experience that I think many people can relate to. Finding that one doctor, therapist, spiritual leader, etc. who seems to understand you, after you’ve been through a hundred professionals who never quite “got you,” is often a turning point in many people’s lives — perhaps a life-saving one.

Her bout with anorexia and bulimia was fully and simply described by the quote “Playing with anorexia is like playing with heroin, fire, plutonium, or Scientology.” — Humorous, yet scarily true. She is so direct and maintains a sense of humor through it all.

I found her connection to certain authors and novels to be interesting also. From Sylvia Plath to Anthony Burgess’s A Clockwork Orange, she showed a very eclectic interest in books with very independent protagonists. She even mentions William S. Burroughs, an eccentric writer of the Beat generation. It seems as though her brief foray into acting was another way to explore, and even become other, various characters.

Pershall’s mention of “splitting,” a dissociatiove experience common to those with borderline personality disorder, shouldn’t be ignored either. Her reference to splitting just before her breakup with Reese was classic.

I’d like to touch on her relationship with religion in response to he disorders. She said it best on pg. 188 with “IF THIS COULD BE PRAYED AWAY I’D BE WELL. ” It also intrigued me when she mentions her father considering mental illness as a sin. That, to me, is a scary, seriously antiquated thought.

I couldn’t imagine writing this review without touching on her tattooing. I understand where she’s coming from when she discusses on pg. 153 ” . . . something that scared me is exorcised, incorporated, with me forever. ” Getting tattoos seems to be her way of facing, and embracing, her fears.

I will end this with her speaking of BPD as an illness “that should be placed on the spectrum of impulse control disorders.” This seems like a pretty solid idea to me, and she goes on to explain it better, getting into the brain chemistry of it. It must also be noted how strongly she speaks of DBT, and how it changed her “because of two things: the focus on the dialectic, or gray area, between good and bad, and the strict adherence to the rules required.” The author speaks so highly of DBT, it seems as though anybody yet to find treatment for BPD or BD should give DBT a shot.

Loud in the House of Myself: Memoir of a Strange Girl
By Stacey Pershall
W. W. Norton & Company (reprint edition): January 23, 2012
$14.95