A different perspective on bipolar disorder

Alice Flaherty isn’t the only physician out there who both suffers from and treats mood disorders. Nevertheless, as this NY Times profile suggests, the 45-year-old with an M.D. from Harvard and a Ph.D. from MIT brings an interesting way of looking at and addressing these conditions, and it’s likely because she’s approaching the issue not from the traditional psychiatric “box” but from the standpoint of someone whose earlier bailiwick was something entirely distinct (movement disorders).

Dr. Flaherty, now 45, is director of the movement disorders fellowship at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School. But those technical descriptors do not begin to capture the way she uses the racing mind of her manic phases to drive her ideas into forceful, highly personal treatments.
“Doctors tend to see patients with an overtone of category,” said the writer Rose Styron, whose husband, the late novelist William Styron, was a patient of Dr. Flaherty’s. “Alice never did. She understood Bill’s depression and his movement problems. But she really understood his needs, appetites, moods, guilts, sadnesses and potential pleasures.”
These days, Dr. Flaherty is preoccupied with the neuroanatomy of empathy — especially the mirror neuron system in the insula, cingulate and inferior frontal parts of the brain, which become active when one person witnesses another experiencing emotion. The routes to her interest were interconnected and highly personal.
“What made me empathic was my depressions,” she said recently. “People’s emotions were pounding me in the face. The mania is like wasps under the skin, like my head’s going to explode with ideas. But the depressions help the doctor aspect of me.”

The two things that are most striking are Flaherty’s embracing of her manic periods and her willingness to see her disease–tripped into existence after she gave birth to stillborn twins ten years ago–as an integrated part of her personality, her being.


The usual model is to tell people diagnosed with depression, anxiety, bipolar disorder and so on that their disease is distinct from “who they are”–something that sits on their mind, perhaps, rather than defines it. Also, the idea of allowing manic episodes to flourish untrammeled, and in fact attempt to put them to use, is generally a no-no: The preferred aim among psychiatrists is to rise from the depressions, nip a racing mind in the bud, and in general stay the middle of the road to the fullest extent possible. (The latter notion goes hand in hand with an apparent de-emphaziing of medications; the article does not explicitly say whether Flaherty takes any herself, but her preferred treatment modalities are much more oriented toward electrophysiological therapies than pharmacological ones.)
Flaherty’s ideas are refreshing because they are far more realistic. We don’t look at the moods of so-called normal people as distinct from their personalities; indeed, we merely accept that they constitute them. But those whose mood swings cross the hazy boundary into pathological territory are suddenly instructed that their moods are “a disease,” like a toxic gremlin leering over each shoulder in turn. This smacks of Cartesian dualism and really makes no sense, especially given the fact that bipolar people are repeatedly told that they will have their “sickness” for life (and rely on meds forever). If you’re going to tell people that they’re going to be who they are for the rest of their days, it makes more sense to frame it in those terms than it does to say, in a nutshell, “You’re sick and you can’t get better, so watch your ass and mitigate your gremlin with this or that chemical.” (If this sounds like an indictment of drug therapy, it’s not, but the reality is that drugs for bipolar disorder have limited efficacy, both directly and longitudinally, as anyone with the condition or a relative who has it knows too well.)
I very much got a charge out of this: “[Flaherty] writes during manias and edits during depressions.” This thought has bounced around in my head in the past, but never coalesced into something so simple and clear. Anyone who thinks that something produced in a manic or hypomanic episode, however powerful the verbiage, will pass muster without being edited later when the author is in a different state of mind might also believe that a cavalcade of drunken monkeys really can churn out Shakespearian works. There is nothing quite so brutal as a mania-soaked screed full of florid language and run-on sentences, especially when the rant is self-referential, which is usually the case.

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  1. #1 by nolrai on March 18, 2009 - 5:03 pm

    I just have to say these points applie to things like ADD too. I mean my meds help a ton, but they dont get me to normal, and I dont think I could deal with normal, I’ve grown up with a brain that works one way, and learning to deal with another way would be very hard.

  2. #2 by nolrai on March 18, 2009 - 5:03 pm

    I just have to say these points applie to things like ADD too. I mean my meds help a ton, but they dont get me to normal, and I dont think I could deal with normal, I’ve grown up with a brain that works one way, and learning to deal with another way would be very hard.

  3. #3 by Rugosa on March 18, 2009 - 8:06 pm

    I live with depression, or as I call it, I’m bi-polar without the fun parts. I understand Dr. Flaherty’s take on accepting the “illness” as part of one’s self. Meds take the edge off the symptoms and help me function day-to-day, but I would not want to lose the deep thoughtfulness that comes with the melancholy. It’s given me a few good poems and a sensitivity to the fragile beauty of life that the perpetually perky don’t seem to take the time to appreciate.

  4. #4 by Steve on March 18, 2009 - 8:07 pm

    I’m not sure I agree with some of the ideas in this post. i don’t think it ‘smacks of Cartesian dualism’ to suggest to people with mental health issues that their moods can be separate from their personality.
    In the same vein, I’m sure nobody regards it as problematic that a key skill for all people to learn in childhood is impulse control, and deferred gratification, and I dont think learning to ignore some of your moods and urges has anything to do with cartesian dualism.
    The distinction between a singular mind and cartesian dualism doesn’t have to be so black and white. We all have an older, more instinctive and emotional part of our brain and a more deliberative part, which are frequently at odds. So without jumping all the way to cartesian dualism, I can handle the fact that there are aspects to my mind and moods that I can grapple with and master, or come to terms with, or deal with, or ignore, etc.
    I think it is very healthy for people to be taught that, to some extent, there moods or even their thoughts can be allowed to pass by without adopting them as central to your identity. How many times have you heard a depressed person who has started a course of ADs say that they now feel like ‘the real me’ and hadn’t before?
    I did enjoy hearing about Dr Flaherty – she sounds as though she has obtained some measure of co-existence with her bipolar. But I imagine that probably relies on her not being so incredibly manic or depressed that it causes serious issues, and I also imagine that it is incredibly challenging to do – this is a highly educated medical professional who sounds like she has a lot of self-awareness. Is the wisdom and control required to accept and live with bipolar in the way she is realistic for most people?

  5. #5 by Kevin Beck on March 18, 2009 - 8:32 pm

    I just typed in the most thoughtful comment in the history of the blogosphere, and this hunk of shit laptop with its fucktarded touch pad grabbed and highlighted all of the text just as I was finishing up and I typed over it all. This happens often, but only when I’m typing something meaningful. God’s will, I guess, just as it’ll be God’s will when the makers of cheap Toshiba computers are smitten all the way to fucking Pluto. Which I’m praying for.

  6. #6 by Kevin Beck on March 18, 2009 - 8:41 pm

    I’ll summarize all of the high-flown shit in my just-eaten comment by saying this: Steve, I don’t disagree at all that actions can be separated from moods (the thrust of your comment), and I am not drawing a strict comparison between true Cartesian dualism and the distinction most psychiatrists like to make between extreme moods and the “real” self (“that’s just your disease talking!”). I find it easier to deal with extremes in my own mood when I accept that these are just a basic fact of my personal quirks and vagaries of neurochemistry, rather than viewing them as a purely external adversary (e.g., a bacterium, a toxin) that needs to be battled with drugs, talk therapy, and so on at all costs and with extreme prejudice. (This is in contrast to schizophrenia, in which people who skip their meds very predictably crash and burn. The “dualism” here seems more clear-cut and more easily traced to a raw chemical imbalance.)
    I’m also not claiming to have “the answers”–I’m just a lifelong fuck-up tossing ideas out there for the heck of it, and I more closely relate to what seems to be Flaherty’s perspective than I do to what I have come to know as the “standard” model.
    Mental-health stategies rarely work for long. Ask anyone who’s tried. What is desirable in this case and what is actually observed are sadly different, and a lot of people will be unstable and miserable forever. Not around the clock, but often enough to interfere significantly with their lives.
    OK, I just about duplicated my other comment, I think. For better or for worse.

  7. #7 by intransigentia on March 20, 2009 - 3:33 pm

    @#4 – I agree. As a person living with bipolar, my thought was,
    (1) If her writing when she’s manic is worth editing rather than just starting all over again, I doubt she’s particularly manic;
    (2) If she can drag her butt to edit her writing, let alone look at her own work with a critical eye without devolving into hopelessness and self-loathing, it doesn’t sound like she’s particularly depressed either.
    I don’t mean to be doing the “oh I have it so much worse; when I was a kid I lived in a cardboard box in the middle of the road” thing, but at the same time I just get really angry with the idea that disability/difficulty is some kind of gift or growth opportunity or some other such saccharine crap, and that people who are living with mental illness should be able to just think and grow their way out of it if they’re smart enough and/or determined enough. Eff that. If mental illness is a gift, it’s a scratchy sweater you have to wear every time you see your grandma because otherwise she’ll think you don’t like it – and you live with her.
    @#6 – strangely enough, I find it easier to deal with my extremes of emotion and the often-bizarre ideas that come with them, more according to the “standard model.” I’m much more comfortable with these ideas being the result malfunctions rather than the true desires of my heart.

  8. #8 by Kevin Beck on March 20, 2009 - 3:38 pm

    intransigentia wrote:
    “I just get really angry with the idea that disability/difficulty is some kind of gift or growth opportunity or some other such saccharine crap”
    Exactly.

  9. #9 by Kevin Beck on March 20, 2009 - 3:38 pm

    intransigentia wrote:
    “I just get really angry with the idea that disability/difficulty is some kind of gift or growth opportunity or some other such saccharine crap”
    Exactly.

  10. #10 by Kevin Beck on March 20, 2009 - 3:38 pm

    intransigentia wrote:
    “I just get really angry with the idea that disability/difficulty is some kind of gift or growth opportunity or some other such saccharine crap”
    Exactly.

  11. #11 by Becky on March 27, 2009 - 2:04 am

    In the book “bipolar bare” by Carlton Davis I learned that bipolar disorder doesn’t have to be a curse. People who have this obstacle in life can get treatment and live a very satisfied fulfilling life- the author Carlton has.

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