Bipolar Diagnosis Is Not An Insanity Defense

I’ve been paging through comments left recently at Chicago news sites regarding the recent revelation that Representative Jesse Jackson Jr. (Congressman, Illinois) has been diagnosed with Bipolar II and is currently experiencing a major depressive episode and is being treated at the Mayo Clinic.  He’s been on a leave-of-absence since June when he was discovered by his father, Rev. Jesse Jackson, exhausted at Rep. Jackson’s Washington, DC home.  The family took Rep. Jackson to Sierra Tucson Treatment Center in Arizona, then moved him to the Mayo clinic where he remains, undergoing treatments for his significant depression.

If the picture I just painted was about your husband or wife, your child, a relative or neighbor, teammate, fellow parishioner, acquaintance, sister-to-the-father-of-your-daughter’s-fiance’s-birth-parents, or celebrity, your reaction, most likely, would contain differing degrees of empathy based in part on your knowledge of mental illness, specifically Bipolar II.  But what if the picture I just painted was about a politician in a state known for its bipartisan political corruption.  The reality that 20% – one in five – of the last century’s governor’s have been indicted or convicted of felonies in Illinois is a damaging statistic to all Illinois politicians.  Damaging is one thing, but suspicion on a federal level and a House Ethics Committee investigation for ties to imprisoned former Illinois governor Rod Blagojevich is quite another.  This federal investigation provides a significant foothold of suspicion in Rep. Jackson’s June disappearance and yesterdays news story confirming his diagnosis and treatment for major depression (one-half of the mental illness, bipolar).

The vitriol posted in comment sections of Chicago area TV stations extolling Rep. Jackson’s disclosure of mental illness and gastric by-pass as a creative and sympathetic smoke screen hoping to derail the federal investigation or, at the very least, to mitigate its voraciousness.  The assertion? That Rep. Jackson was in the middle of a hypo-manic (the other half of the mental illness, bipolar) episode which characteristically emboldens the patient to behave dangerously, generate grandiose plans well beyond his normal specter of life, and indulges in dangerously poor judgement particularly in highly sensitive or personal areas of the patients life.  If Rep. Jackson never mentioned (prior to the Blagojevich sting) that he’d like to advance his political career by winning a senate seat and then suddenly (and privately) begins the high-stakes game of buying (rather than campaigning for) a senate seat, Rep. Jackson could defend his uncharacteristic behavior as that of his manic-self (though at the time he was unaware of his mental illness), and that if his bipolar diagnosis was being properly treated (and he was compliant) he would’ve steered clear of any illegal activities.

Which is, by the way, a creative and sympathetic defense.  But our legal system does not recognize bipolar disorder as insanity, and therefore cannot be used as a defense in legal proceedings.  It could pluck on the heart strings of those on the House Ethics Committee, but any preferential treatment Rep. Jackson hopes his bipolar disorder might garner will be sanctimonious.  However, if the Committee (and subsequently Federal Prosecutors) sense blood in the water, Rep. Jackson’s recent disclosure of personal and private information will be sympathetically and respectfully noted.  And then the hounds will be unleashed and will, eventually, tree the red fox.

But what I find the most deplorable is the velocity and distribution of judgement by every-day citizens whose faith in politicians has been crushed by an unending parade of scandal, corruption, and greed.  Jesse Jackson Jr.’s job is a congressman.  Jesse Jackson Jr. also happens to be human, a husband, a brother, a son, a friend, and now part of my bipolar II world. 

It is shameful that the suspicious and the quick-to-judge deny their empathy to the mortal and vulnerable  Jesse Jackson Jr. who is suffering horribly, whose life is teetering on pharmaceutical roulette, who goes to sleep dreadfully depressed and wakes to the loathsome, disastrous, and painful reality that he must learn to live with bipolar disorder, not suffer from it.  To those casting stones, humanity and empathy aren’t yours to keep; they are given.  I pray that one day you won’t stare into the cold eyes of a stranger wholly disinterested in your immediate suffering because of a far-off suspicion of guilt.

Maybe Bruce Banner, Tony Stark, Logan, Bruce Wayne & Clark Kent Were Bipolar

I’ve identified the significant trigger, which, if pulled, catapults my otherwise sensible, responsible, and respectful self into a derivative of me, but one which possesses out-of-this-world dynamism akin to superhero’s or mutants.  The physical me doesn’t change, just the degree of acumen and acuity I’d refined in furtherance of a twenty-year career playing The Fool to a cadre of Somebody’s.  These heavyweight’s attained their ascendency via marriage; owning an avaricious, pugnacious and predatory law firm; partnership with an iconic architectural firm; ruthless attorney for corporate raiders.  Not one cared about procedure; they simply expected what they’d requested.  Failure was my burden to bear and under which I would suffer.

Only once did I return empty-handed: “I flew to Florida; drove to the grove; oranges are out of season; no juice.”  She pushed her Eames chair away from her desk and stood in front of me, “Do I look like an idiot to you?  I mean, when you think “idiot,” is it this face you see?  Because that’s precisely what you so deftly hand-delivered.  But I didn’t ask for an example of an idiot, did I?  I mean, if I did, which I didn’t, but if I did then you could get a mirror from one of the secretaries.  You wouldn’t simply fire-up the Ol’ Gulf stream and coast to Florida (at $2,350.00 per flight hour plus pilot time, hotel, fuel,, and food).  No, no explanations: I asked for orange juice from “Lily’s Grove,” of which I own by the way: Oh!  Didn’t you know that?  What?  No investigation before you saddle-up and zoom to Miami?  When I’d heard from Jorge that a “chiquito desmandares” demanded that he sell him orange juice for his “gillpollas cacia” the only conclusion I could draw was, “Mulligan must think I’m an idiot!”  Since you’re absolutely certain there’s no orange juice from Lily’s Grove, just for fun, let’s see if I might know someone who could help. . .Buenos dias, Jorge. . .”

That lesson (failure) provided an essential insight: if a heavyweight asks for something that has the appearance of impossibility, they already know where and how to get it.  They simply aren’t interested in doing it for themselves.  Self-effacing, tenacious, and propriety could be helpful behaviors in discovering a source for this item.

Only when forethought (plan B, escape route) is absent and I discover that I’m in a wholly defensive position with no options does this derivative of self appear.  This derivative is my super-hero or, as I now recognize, my manic-self (who I will name “Heartless”).  “Heartless” has a single purpose: self-preservation amidst unyielding stress, confusion, and fatigue, the by-products of an extremely complicated problem or series of problems which causes inescapable mental burden and my organic belief that failure cannot be considered because of its dire consequences and the real-life ramifications to everyone involved.

“Heartless‘s” appearance goes unnoticed and the logjam that promoted his incantation begins to loosen and the stalled efforts discover renewed vigor, and less and less sleep is needed, and more and more and more organization and meticulous paperwork are demanded.  “Heartless” remains present for varying lengths of time: Sometimes 3 months, sometimes a year.  But his denunciation follows the same pattern: “Heartless” turns his attention away from the situation of which he was borne, and on to me, which he sees as the real victim of the entire circumstance.  And then he uses every weapon in his arsenal to create as much collateral damage as possible: spending huge amounts of money on items which I’ve wanted, yet dare not buy (dog, tattoo, Rolex GMT II, 55″ TV, fully outfitted wood shop, custom-made Japanese fountain pen); ingesting too little or too much of my medication; abhorrent social behavior; and the worst and most pointed, vehement, and hateful: accusations and ceaseless arguments with my spouse.

The moment someone, anyone really, recognizes that I’m in the midst of a manic crisis, “Heartless” disappears.  And all that’s left behind is a meandering trail of damage, some salvageable, some not.  Destruction is definitely his foot print.  But I’ve considered too, that perhaps “Heartless”buys and says and behaves in ways some tightly-tucked-away part of me wants to behave or say or buy.  But I, like so many of us, have toed the civil line and buried our uncensored selves in a nook no one will find.  Wouldn’t it be tragic if we’ve been taught that decorum dictates that superhero’s remain in comic books and not shopping at Prada.

 

What Flavor Is Your Mood Disorder?

“What’re you having?” the rakish twenty-something asks.  Still staring into the fluted dish before me, spoon in hand yet inactive, I respond, “I’m not sure exactly.  I asked for a double-scoop of Desire and was handed this.”

The twenty-something turns so his torso, while dissected by the cafe table, is visible to me, “What’s it taste like?”  Turning my head in his direction I realize he’s: 1) That “guy-in-the-tuxedo” from my cousin’s Mystery Date game; and 2) Sans the tux!  I asked myself, why would “Mr.-Mystery-Date-Man” be sitting in a soda fountain, at a table next to mine, wearing only a smile?  My chagrin whips my gaze back to the disappointing confection now taking the shape of a poached egg.  “Well,” I stammer, still shaken by his cheeky immodesty and dismayed by my immediate craving for carnality, carousal, and covetousness, “It hints at Desire, but clearly an inferior attempt; the delicacy of Desire is overwhelmed by the coarse texture and indulgence.”  I decided to shift my chair and face the tempest of his proximity head-on, “What’s that you seem to be enjoying?” I ask, sounding foolish.

“A Raspberry Restraint,” he said as the spoon scraped and clanked against the spotless bowl.  “I have at least one every day.  I could probably eat fifty.  Moderation, that’s what I hear, everything in moderation.  Who’re they trying to kid?  I can spell; and I assure you that there’s no Mania in moderation,” he said as he slid slowly forward in his seat, the heat of his knees gently toasting my flank; “Sounds like they did the switcheroo. . .gave you a two-scooper of Licentious Lingonberry; they do that when they’re out of Desire.”

Flabbergasted, I now understood why I was staring at the freshly filleted fellow, splayed before me like an all-you-can-eat-buffet stocked with preprocessed food.  “But I wanted Desire. . .gentle, demur Desire. . .subtly prurient, hopeful and hungry. . .Desire. . .in general terms!”  Sounding exasperated, I wave my hand indicating his wanton availability, “Licentious Lingonberry?  No wonder it tasted so obviously. . .bitter. . .each spoonful made me thirstier. . .and there you were, the perfect glass of ice-water.”

I pushed my chair back and stood up trying in vain to disguise my arousal, “Sure, you’re lust personified; carnal; and after, I’m right back here; the one place where we can savor those flavors of humanity lost to us; before we go back to our senseless mockery of life,” I said as I began to leave.

“Sounds to me,” Mr.-Mystery-Date-Sans-Tux shouted, “like you ought to have ordered the Passion Fruit!”

An Open Letter to U.S. Representative Jesse Jackson Jr.’s Mayo Clinic Physicians

Dear Dr. So-and-So, et. al.:

I read with tremendous interest and a degree of de ja’ vu the front-page story written by Ms. Michael Sneed in the Sunday, August 5, 2012 Chicago Sun-Times which reported that U.S. Representative Jesse Jackson Jr. recently collapsed and had become completely debilitated by depression.  Upon reading the story, I experienced a staggering degree of recognition, for I too, have (and continue to do so) hit the same kind of wall as Representative Jesse Jackson Jr.: A crippling mental illness diagnosis, specifically major depression (changed later to Bipolar II) following gastric by-pass surgery.

The story reported that Ald. Sandi Jackson (wife of Representative Jesse Jackson Jr.) doesn’t know if her husband’s depression is connected to his weight-loss surgery.  As a person who finds himself in a very similar situation the development of major depression after elective gastric by-pass surgery) I would like to suggest that determining the cause of this on-set of depression is irrelevant and nearly impossible to determine.   Based on the past four years of failed orally administered pharmaceutical treatment attempts, I strongly suggest that you titrate the dosing levels of psychotropic therapies dramatically (50%-75% higher) or increase the potency of the psychotropic therapies to compensate for the substantial degree of malabsorption (the basic tenet of Duodenal Switch Surgery) caused by the significant reduction in stomach volume (up to 70%) and the dissection and rerouting of a large percentage of the small intestine (which is largely responsible for caloric absorption).  If the goal of the Duodenal Switch surgery is to limit volume and reduce absorption of food ingested orally, then common sense suggests that anything ingested orally will greatly lose its effectiveness (especially if the drug’s efficacy during clinical trials was based on subjects that did not undergo weight-loss surgery).  Except now we want the body to absorb what it’s ingesting!

I endured two needless years of trial and error attempting to discover pharmaceutical regimen which would lift me from depression and put a lid on my mania.  My psychopharmacologist knew I’d undergone gastric by-pass surgery a decade earlier yet refused to consider malabsorption as the cause of the ineffectiveness of every single prescription.  Frustrated by my psychiatric team’s myopia, I returned to the care of my internist; he was the first doctor to consider that my body’s ability to absorb oral treatments had been reduced by as much as 75%.  If an increase in dosage is impossible, then a different delivery system (IV, inhalation, transdermal patch, suppository) must be manufactured.   Please don’t waste Representative Jesse Jackson Jr.’s time prescribing the usual litany of drugs at their recommended doses: It’s akin to trying to stop a charging elephant with a water pistol.

Morbidly obese patients who were diagnosed as depressed and were being treated successfully through oral medications prior to gastric by-pass surgery discovered that post surgery their depression worsened and their pre-surgery oral medication treatment failed to reproduce the expected degree of pre-surgery success and relief.   Your patient is in crisis; your patient is experiencing a major depressive episode; your patient’s natural ability to absorb what he ingests has been compromised to the degree of ineffectiveness; your patient needs an extraordinary, preposterous, wholly unimaginable antidote, not a boilerplate solution. 

I salute the Jackson family for supporting Representative Jesse Jackson Jr. through this difficult period and wish them all God’s speed.

Find Humphrey at “www.humphreytales.com”

Me-Wow!

“Humphrey Tales” has become the cat’s pajamas in the blogosphere.  Especially in the 11-17 year old female demographic.  Of which I am very happy.

But my initial reaction was, “Uh-oh, what’s this going to do to my blog?”   What about those other subjects of my posts?  Mental illness, bipolar disorder, depression, homosexuality, politics, pedophilia, physically and mentally abusive childhoods?  Sure, most kids nowadays have developed a fairly broad view of their world (thanks in part, to the content found on the internet).  Unfortunately, kids these days face a degree of reality I personally never encountered until college, and even at that age, there were topics I found troubling and behaviors I never understood.  So how might a thirteen-year old girl react when she finishes reading a post about Humphrey conquering a bear rug, then clicks on a post entitled, “My Moral Corruption,” or “And Yet She Cried the Day He Died,” or “Back Then, Ignorance Was De Rigueur?”

“To thine own self be true. . .” isn’t license to write and post anything on the internet without a certain degree of social decorum. civility, and ethical responsibility to your potential audience without due warning.  Writing offensively and then posting it on a publicly available blog site isn’t poetic license, it’s the shameless abuse of liberty and scribbled diarrhea at its most contemptible.  A writer who’s writing in the public arena bears his or her own fundamental responsibility of proscription: Will this post make a difference to anyone but me?  Anyone who thinks proscription doesn’t apply to them isn’t a writer, they’re a propagandist!

And on that note, I am very happy to announce that Humphrey now has his very own blog: www.humphreytales.com.  There you’ll find the past and future adventures of Humphrey and all his friends.  I hope you’ll take a peak!

And to the “Humphrey-Following-11-17-year-old-female-demographic:”  this blog’s got nothing to offer you; take your time growing up; redirect your browser to www.humphreytales.com.