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“For there’s a change in the weather. There’s a change in the sea. So from now on there’ll be in change in me”. This the time of year when there are quick increases and decreases in temperature. It can be sunny and eighty degrees and then rainy and forty. Weathermen talk about high and low pressure fronts moving in. Huge rainstorms related to El Nino and man made climate change are shown on very detailed TV screens. It all sounds very scientific until you have to experience it. Changes in our own moods can be like that and can be very difficult to deal with for all of us. Why is it that one day you can be happy and everything looks wonderful and the next you feel as if you are in Death Valley ? Bi-Polar Illness ,or Manic-Depressive disorder as it used to be called, is a very popular illness. Countless celebrities claim to have it. It is constantly used as a defense in criminal cases ,but how much of it is real. It used to be that all it took was one “manic” episode over a lifetime to be diagnosed with it. Now there are various gradations of the condition.

I remember the extremes. There was a man trying to row his small fishing boat across his grass-covered lawn; another man tried to convince the psychiatric unit that he had discovered a new theory of relativity. There was a man who was a top advertising executive. He refused to take any medications because he was most successful when he was in a manic phase. Then there are the cases where people really do get into trouble. There were suicides from people in extreme depressive states. There was a nurse who had literally crawled out of her illness and was managed quite well on meds. She became a top flight psych nurse and was the head nurse at her hospital. She had been managed on lithium for years, but then the lithium began to attack her kidneys. Other meds were tried, but none of them worked as well . She had a series of severe manic episodes and lost everything. She has now been on psychiatric disability for years.

One man came into my office extremely upset because the FBI and CIA had targeted him and were eavesdropping on his phone calls and all of his conversations. He was convinced that there were even listening in on our conversation. He was thankful that he always carried a gun to protect himself. After much maneuvering and convincing, he finally agreed to go into the hospital. He improved and stabilized, but he was furious when he found out that his hospitalization had cost him the ability to own firearms. After a few years he was able to get that privilege back, but he continued to bring it up in therapy and still had a real distrust of the government and all health care providers.

I think it’s the loss of ability to reality test that is the concern. The extremes that end up as psychoses can be pretty obvious. When you talk to someone in the middle of a cycle, they really don’t want to accept that there is anything wrong with them. Everything seems logical and they cannot understand why you don’t “get it”. Some people have milder forms of the illness. They can either go on meds or not. They seem able to deal with the sudden mood swings. One woman said that for her it was seasonal. Every spring and in late fall she would experience this. Another person had a bad experience with a recreational drug that triggered his manic episode. For him it was inability to sleep, heightened irritability. For some people it is compulsive shopping, gambling , promiscuity, poor judgment. These episodes can often lead to comments like “What the hell is wrong with you ?” No incident of the illness is exactly the same. I think that is why mental illness is so poorly judged.

Measles, Chicken Pox, Intestinal Flu all have symptoms that can be seen and measured. This doesn’t happen so much with mental illness. It is hard to measure someone’s internal state. Years ago there was a patient who tried to explain this to some of his friends. They couldn’t understand why he couldn’t drink. He tried to tell his friends that when he drank he “broke out”. When they asked his what kind of break out, he told them “I break out windows ,doors and peoples teeth!”  His friends suddenly were not quite so enthusiastic in pushing him to drink.

Unfortunately most mental illness cant be explained like that. There is no one answer. If you are going thru it, don’t give up, there is help. Just try and be open to the possibility of things getting better. Hope and support are probably the best medicines we have. Just keep trying.

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I suppose this is the time for me to begin thinking about this, but I just don’t picture myself as old yet. Some days it is more difficult to get moving and some days my aches and pains are more evident. Some days it is harder to remember even the simplest things, but my wife says I have always been like that. I don’t think of myself as almost 70. I don’t know what age I am. I am certainly not 21 or 31. Maybe I’m still really only in my 50s. Some days it feels like that and on my good days maybe only in my 40s.However when I look in the mirror I now see some hairs that are no longer just grey. They are white. I have thought about the beard darkener that is advertised on TV, but I would probably end up with a green beard or one that glows in the dark. This adjustment to ageing is still a challenge. I am still fascinated by how others work thru this. Maybe the real secret is not to think about it, but then I think I would be missing something important.

Erick Erickson’s last stage of development is Ego Integrity vs. Despair. Hopefully this is where you can contemplate a positive summation of life. I remember many patients who had difficulty with this and many who were able to achieve it. There was a woman in her mid 70s trying to work thru the death of her husband. He had been a very successful businessman and had died of progressive heart disease at 76. She had a very difficult time with this and began to use alcohol to cope. Her children were very concerned and sent her to us. She was able to stop drinking and maintain sobriety. She was also able to work thru some of her grief. The more she talked about her husband the more she laughed. One day she came in and told me it had been a difficult week. She told me “yesterday would have been our 52nd anniversary”. She also told me that their wedding picture was on the fireplace mantle in her home. “I still talk to him every day— I met him when I was 15 and was never with another man—do you think I’m crazy?” I offered her much support and as the therapy continued, she continued to talk to her late husband. She still felt the tremendous loss but was able to focus on the many positives of their life together.

During that same week the clinic received an emergency call re an 81 y/o man. His son was quite concerned and asked for a work in appointment for his father. The son said that both his mother and father were no longer able to live independently. The mother had just had a small stroke. He had found an assisted living facility that would take both of them, but his father didn’t want to go and had even hinted at suicide. The assisted living facility did not want to take the father until he had been assessed. When I talked to the father I told him we could help him with his depression and arrange for the transfer. He said, “You don’t understand—we have had a terrible marriage. My wife is an awful person and has made my life a living hell. Now they want to put us in a place where we can die together!!” His son agreed that his parent’s marriage had not been good. The mother was transferred, but the father continued to live in the family home. According to the son he seemed much happier.

Relationships can obviously have much to do with general life satisfaction. One of the most important decisions we can make is about our life partner. There are many stories of people in long marriages dying within a year of each other. Yet it still depends on how you define yourself and where meaning in life comes from. Relationships are not the only way to judge a positive life. There was another patient who was a very successful chemical engineer. He had developed many products and even had his own specific patents. When he retired he was overcome with depression. Due to his commitment to his work, his marriage was in second place and after the birth of their two children it fell even further down his list of priorities. When he retired he realized that his wife had developed her own separate life. His adult children had moved away and he had nothing. He began his own consulting firm and this helped. He also developed a real interest in bridge and joined some of the bridge groups in his area. He continued in therapy for many years. He finally accepted his responsibility in what had happened in his marriage, but neither he nor his wife really wanted to change. They were content in the way their lives had developed.

My brothers-in-law and I have an acquaintance that can’t understand how we all decided to retire. He even suggested that we start another business “just to keep you all busy”. He has his own business and has had for over sixty years. He has told us all that he has no plans to retire. He appears to be very happy and will keep working until he falls over. He loves his work and his devotion to it shows.

As I sit here and begin thinking of all of these things, I am grateful for what I have and what I had. I had an opportunity to talk to some of the most interesting people in the world. I have a wife who is still the one person who can consistently make me laugh and who continues to surprise me on almost a daily basis. I know that there is still a ways to go and much work to do. Hopefully I’ll continue to try without using any special hair products.

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Do you remember the first movie you ever saw? I remember taking my 6 y/o and 2 y/o sons to see a Star Wars movie. My youngest son napped thru the first part and then woke up when the Ewoks appeared. He began talking loudly and stayed awake the rest of the movie.

I think the first movie I saw was Pinocchio. I still remember the start of the film. All of the old Disney films were hand drawn and were beautiful. They all had happy endings and promoted positive values. Cinderella, Sleeping Beauty, etc, all taught a lot about kindness and inner goodness. My favorite was Dumbo. The little elephant with big ears that everyone rejected. He finally was able to discover his talent and fly with help of a “magic feather”. I’ve often thought about that as a therapist. The “feather” obviously wasn’t what made Dumbo able to fly, but because he believed in it, he was able to. When he finally let it go he found that he had the ability to fly all along. I think that a lot of therapy is about giving someone a “magic feather”. If they believe in it strongly enough, change can happen. There are lots of techniques to do this from cognitive behavioral therapy to mindfulness, meditation and even anti-depressant medication. Some people report almost immediate results from the meds when we know most medication take from 3-12 weeks to achieve results. It’s the individual’s own belief in the ‘cure’ that is important.

There is a very old study about troubled couples deciding to enter therapy. The results of the study were that the decision to enter therapy often was at least as helpful as the therapy itself. Couples who were on long waiting lists often showed as much improvement as couples actually in therapy. The authors hypothesized that this didn’t show the uselessness of therapy, as much as it showed the decision to enter therapy was the key factor in achieving change—the “magic feather”.

There is still so much stigma attached to seeking counseling/therapy. It is still looked on a sign of weakness. We often had people trying to hide if from their insurance companies. I had people who didn’t want their spouses, parents, or children to know that they had made the decision to ask for help.

A lot of people would come in for their first session and be surprised that there wasn’t a couch in my office because that’s what they imagined therapy was about. The importance of helping people relax and begin to trust was essential. I would try to be as supportive as possible to help achieve this. The importance of developing trust and a developing a therapeutic alliance is what the beginning of therapy is all about.

The “magic feather” part comes later when the therapy is progressing. You get to know each other and talk about what is really possible. Not everyone can fly, but everyone has the ability to change. It just depends on how change is defined. In the hospital many years ago, a 16 y/o girl was admitted. Her parents didn’t know how to handle her and told us she was out of control. She was doing drugs, flunking school, and staying out all night. She was the youngest of four girls. Her sisters had all run away from home at 17 by leaving out a rear window. They would come home a year or so later with a husband, a baby, or both. The parents wanted their youngest to not make that same mistake. After she left the hospital she did well for a while, but then began to slip. Her parents were able to set some clear limits. When she left at 17, she left through the front door after saying goodbye to her parents. She had some additional struggles, but then settled down and has had a fairly successful life. Now this might not seem like an important change, but it was to her parents. They thanked the whole hospital staff for the change in their daughter when it was probably them that changed the most. It’s important to help people accept that they are the ones who are doing the work.

It’s very common for people to put their therapists up on a pedestal and give them all the credit for any positive change. I would always resist this. I had no need to be anyone’s false idol. We are all responsible for our own lives. Some patients don’t want to accept this. They want their therapists to “fix them”. The problem with taking credit for anyone’s success is you also make yourself liable for their failure. I didn’t want anyone to be that dependent on me. The decision to enter therapy is hard enough; the decision to stop can be even harder. In the old days therapists would see their patients weekly to semi-weekly (2x per week) for 90 minutes or longer. This could go on for years with patients making very small incremental changes. Now it is a lot different. Insurance companies and the real business of everyone’s lives wont allow that. I did have patients that came to see me for years and some patients only for months. I would tell them all about the Hotel California. “You can check out any time you like, But you just can never leave!” Therapy shouldn’t be like that.   Dumbo didn’t have to hold on to his magic feather forever. He was able to let it go and get on with his life. Therapy should be about supporting and encouraging you to realize your own strengths and abilities. You should always be able to leave when you get what you want. This doesn’t mean you can’t come back if something else happens. Just remember the address and phone number.